, Volume 471, Issue 7, pp 2132-2136
Date: 09 May 2013

Patients With Unstable Slipped Capital Femoral Epiphysis Have Antecedent Symptoms

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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.


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


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.


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.


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.

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Children’s Hospital Boston, MA, USA.