Slipped femoral epiphysis

Definition/diagnostic criteria Slipped femoral epiphysis (SFE) is characterised by the displacement of the growth plate in the femur, leading to the slipping of the ball at the upper end of the femur. The condition primarily affects adolescents and can result in significant deformity and dysfunction if not promptly and appropriately managed.

Epidemiology The exact incidence of SFE in the UK is not clearly defined; however, it is considered a common condition in paediatric orthopaedics. The prevalence is noted to be higher in certain demographics, such as adolescents, particularly those with obesity or endocrine disorders.

Diagnosis Diagnosis of SFE is typically based on a combination of clinical features and investigations.
Clinical features: Patients with SFE often present with hip or knee pain, limping, and sometimes with a history of minor trauma. The pain is usually insidious in onset and may be associated with a reduced range of motion in the affected hip.

Investigations: The diagnosis is confirmed through imaging studies, primarily radiographs of the hip, which typically show displacement of the femoral epiphysis. Advanced imaging modalities like MRI can be used in certain cases for detailed assessment.

Treatment The management of SFE primarily involves surgical intervention. The specific type of surgery depends on the severity of the slip and the overall health of the patient. In the UK, open reduction of slipped capital femoral epiphysis is an evidence-based recommendation, aiming to correct the position of the slipped epiphysis and reduce the risk of avascular necrosis​​.

Prognosis The prognosis of SFE largely depends on the severity of the condition at diagnosis and the timeliness and effectiveness of treatment. Early diagnosis and appropriate management can lead to good functional outcomes, while delays can lead to complications such as avascular necrosis and chronic hip dysfunction.