What's the Diagnosis? By Dr. Loran Hatch

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



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.