Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts

Clinical Orthopaedics and Related Research®

, Volume 471, Issue 7, pp 2132-2136

Patients With Unstable Slipped Capital Femoral Epiphysis Have Antecedent Symptoms

  • Thomas G. McPartlandAffiliated withUMDNJ-Robert Wood Johnson Medical SchoolPediatric Orthopaedic Associates Email author 
  • , Wudbhav N. SankarAffiliated withChildren’s Hospital of Philadelphia
  • , Young-Jo KimAffiliated withHarvard Medical School
  • , Michael B. MillisAffiliated withHarvard Medical School

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Abstract

Background

The characteristics of patients who sustain unstable slipped capital femoral epiphyses (SCFEs) are not well described compared to their counterparts who sustain stable SCFE. Although patients with unstable slips are usually identified owing to acute symptoms, it is unclear whether these patients have premonitory symptoms that could heighten the awareness of treating physicians to the possibility of an unstable slip and lead to timely diagnosis and treatment.

Questions/purpose

We determined whether most patients experienced pain and limp before developing an unstable SCFE.

Methods

We retrospectively reviewed 582 patients and identified 82 (41 boys, 41 girls; 85 hips) with unstable SCFEs. Patient records were reviewed for sex, age at onset, weight at onset, and presence and location of pain and/or limp before the unstable slip. Boys averaged 13 years of age at the time occurrence and weighed on average in the 77th percentile. Girls averaged 12 years of age at the time of occurrence and weighed on average in the 79th percentile.

Results

For all patients, 73 of 82 (88%) had pain in their hips, thighs, or knees for an average of 42 days before sustaining unstable SCFEs. Sex distribution was equal for patients with unstable SCFEs.

Conclusions

Patients who sustained unstable SCFEs had premonitory pain in the limb. Early recognition and an appropriate diagnosis provide a critical opportunity to prevent a morbid unstable SCFE.

Level of Evidence

Level IV, diagnostic study, See Instructions for Authors for a complete description of levels of evidence.