Slipped capital femoral epiphysis: the importance of early diagnosis.

Slipped capital femoral epiphysis typically occurs in adolescents. Presentation may include limp or vague pain in the hip, thigh or knee. Knee pain, in particular, is a common complaint among adolescents and may be due to patello-femoral syndromes, Osgood-Schlatter disease, patellar tendonitis, or chondromalacia patella, to name a few. However, it is vital to remember that the complaint of knee pain may be present because of referred pain from pathology at the hip. Every child presenting with a complaint of hip, thigh or knee pain must undergo a hip examination. Likewise, a "groin pull" is exceedingly rare in children and must be a diagnosis of exclusion. Any child with complaints of hip, thigh, or knee pain, or physical examination findings of out-toeing, decreased internal rotation, or obligate external rotation with flexion, should be presumed to have SCFE until proven otherwise. There is a high rate of delay in diagnosis of SCFE, which leads to opportunities for progression of deformity, which in turn leads to increased risk of arthritis. Delay in diagnosis also may allow a stable SCFE to become an unstable one, with a much higher risk of development of AVN. When suspected, the diagnosis is confirmed with x-rays (AP and frog-lateral of the pelvis). Therefore, a high index of suspicion for this disorder, and the attainment of appropriate radiographs, should allow for prompt diagnosis and referral for treatment. Treatment is urgent and surgical. Early diagnosis and proper treatment are the mainstays of prevention of adverse sequelae.