8 yo F presents to the ED c/o L hip pain. Reports fall 1 month ago, xrays done at OSH were negative. She has been using crutches to ambulate due to pain. She is sent to the ED today by orthopedics. XRays of the L hip are done and shown below. What's the diagnosis? (scroll down for answer)

Answer: Slipped Capital Femoral Epiphysis (SCFE)

• Incidence 10 per 100,000 children; usually 8-15 years of age, males > females
• Risk factors: obesity, adolescent growth spurt and endocrine abnormalities
• Symptoms/Exam findings: 
• poorly localized pain to hip, groin, thigh or knee
• limping
• limited internal rotation
• leg length discrepancy
• Diagnosis: bilateral AP and frog-leg lateral views (if stable) or bilateral AP and cross-table lateral views (if unstable). See xray image below:

• Mangagement/Treatment: non weight bearing, urgent orthopedic referral
• Stable SCFE: in situ fixation
• Unstable SCFE: may require open reduction and fixation
• Complications:
• Avascular necrosis (occurs up to 50% in unstable SCFE)
• Chondrolysis, loss of articular cartilage, pain and stiffness
• Femoroacetabular impingement

References:

Millis MB. SCFE: clinical aspects, diagnosis, and classification. J Child Orthop. 2017;11(2):93–98. doi:10.1302/1863-2548-11-170025

Peck DM, Voss, LM, Voss TT. Slipped Capital Femoral Epiphysis: Diagnosis and Management. Am Fam Physician. 2017 Jun 15;95(12):779-784.