Slipped Capital Femoral Epiphysis: Rapid Evidence Review

Slipped capital femoral epiphysis occurs in childhood and adolescence and is associated with potentially serious lifelong complications and sequelae. The incidence of slipped capital femoral epiphysis appears to be increasing as rates of childhood obesity increase. Patients may have a noted limp and present with poorly localized pain in the hip, groin, thigh, buttock, low back, or knee. Pain increases with activities that require hip flexion, such as squatting, prolonged sitting, and riding a bicycle. Inspection may reveal an antalgic walking pattern with a Trendelenburg gait and external rotation of the leg. Passive flexion of the hip may induce an obligatory external rotation and abduction (Drehmann sign), and internal rotation of the hip may be limited. Slipped capital femoral epiphysis is typically diagnosed from anteroposterior pelvis and frog-leg radiographs. Initial management focuses on decreasing complications and long-term sequelae by halting further slippage. To limit progression, patients should be immediately placed into non-weight-bearing status and urgently referred to an orthopedic surgeon for surgical fixation. Return to activity or sport depends on a gradual increase in activity that normally lasts approximately 6 months after surgery.