Slipped Capital Femoral Epiphysis in Atypical Patients.

When patients who are thin present with knee pain, it can be easy to overlook the possibility of slipped capital femoral epiphysis (SCFE). Although 80% of patients with a "slip" are obese, thin children are not immune to this problem. Endocrinopathies, especially hypothyroidism, can be associated with SCFE. This article describes guidelines for evaluating patients for a slip and highlights some important considerations for the atypical SCFE. Patients with open growth plates with thigh or knee pain should routinely have a hip examination as part of the evaluation. Plain radiographs, with an emphasis on obtaining a frog lateral image, are usually sufficient to make the diagnosis of SCFE. Patients diagnosed with SCFE should be immediately referred to an orthopedic surgeon because treatment for this condition is always surgical.