Master Slipped Capital Femoral Epiphysis (SCFE) with Picmonic for Medicine

The femoral epiphysis, also known as the epiphyseal plate, physis, or simply growth plate, is the junction between the femoral head and neck, and is primarily composed of cartilage. During adolescence the femoral epiphysis is rapidly expanding and it poses as a weak point between the bones until the growth plate fuses and the femoral head and neck become one solid bone.

Moving distally to proximally inwards, bone anatomy consists of the epiphysis with underlying epiphyseal (growth) plate, the metaphysis, and diaphysis. SCFE occurs when there is separation along the epiphyseal plate at the femoral neck.

Obese adolescents are at much greater risk for SCFE due to the greater mechanical stress placed on the hip joint.

Male to female ratio of SCFE cases is 1.5 to 1.

SCFE occurs more commonly in African Americans.

Imbalances in growth hormone (or somatotropin) and sex hormones (progestogens, estrogens, and androgens [which includes testosterone]) can lead to abnormal growth patterns and bone ossification, which will predispose to the development of SCFE. Other endocrinopathies like hypothyroidism, growth hormone deficiency, diabetes, and Cushing syndrome may contribute to SCFE.

Interestingly, these patients often present with thigh or knee pain (referred pain), not hip pain - when the problem is actually in the hip! Patients will report no history of direct trauma to the affected side. Pain is exacerbated by physical activity.

Patients may be unable to bear weight due to pain on the affected side. As they attempt to compensate, they may begin to stress the contralateral side, and may eventually manifest with SCFE on that side.

Patients will have very limited internal rotation and abduction of their hip and thus demonstrate obligate external rotation of their hip with flexion.

Patients will have very limited internal rotation and abduction of their hip and thus demonstrate obligate external rotation of their hip with flexion.

This specific plain film radiograph view is used to evaluate the hip and surrounding structures. Diagnosis of SCFE can be made by observing the epiphyseal plate deformity on X-ray. Caution is warranted because moving the leg into this position can further exacerbate an unstable case of SCFE.

Use of surgical screws (pins) is the most widely used treatment to stabilize the epiphyseal plate and avoid complications. A solitary screw is drilled into the bone and prevents further slippage.

Osteonecrosis can occur due to compromise of the femoral head blood supply due to the slippage of the initial injury or as a complication of corrective surgery. Untreated avascular necrosis can lead to loss of function of the affected hip. Patients with this complication may complain of persistent hip pain despite prior repair. Other complications of SCFE include chondrolysis and osteoarthritis.