History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include obesity, puberty onset, and endocrine disorders.

weight (>90th percentile)

Childhood obesity correlates closely with increased incidence of SCFE.[5][11][12][13] Weight ≥90th percentile in 63.2% of children with SCFE in one study.[14]

gait with affected leg externally rotated

Observational gait analysis is an important part of diagnosing SCFE.

Other diagnostic factors

common

groin or knee pain

Referred pain to other locations is common and can cloud the diagnostic picture.

bilateral hip pain

SCFE is known to occur bilaterally in 60% of cases.[23]

Trendelenburg's gait

Results from altered hip mechanics. The child may lean the trunk towards the affected side. The test is performed by having the child stand on the affected leg with the knee flexed and the hip extended.[21]

restricted range of motion

May be evident on passive and active flexion of the hip.

uncommon

weight (<50th percentile)

May indicate underlying endocrine disorder.

symptoms of hypothyroidism or panhypopituitarism

SCFE may be the initial presentation of an endocrine disorder.

renal failure

SCFE may be the initial presentation of a metabolic disorder such as renal osteodystrophy.[24]

recent trauma

Children who present with extreme hip pain may have unstable SCFE due to trauma (e.g., sport injury, falls).[6]

Risk factors

strong

puberty

Peak age of diagnosis is between 11 to 12 years for girls, and 12 to 13 years among boys.[11][12]

Hormonal involvement associated with the adolescent growth spurt may also provide insight into the aetiology of SCFE. The physis weakens at puberty, possibly due to the effect of circulating gonadotrophins.[7]

obesity

Childhood obesity correlates closely with increased incidence of SCFE.[5][11][12][13] Weight was ≥90th percentile in 63.2% of children with SCFE in one study.[14]

Obesity increases the shear stress across the physis, weakens it, and causes the characteristic displacement in SCFE.

endocrine disorders

Hypothyroidism, panhypopituitarism, renal osteodystrophy, and growth hormone deficiency (typically after supplementation has begun) are all associated with the condition. However, the majority of children with SCFE are obese and have no identifiable endocrine disorder.[7][15] One study found increased leptin levels in patients with SCFE, regardless of obesity status.[16]

weak

male sex

Sex differences have been noted, with rates for males higher than those for females.[9][11]

ancestry

Incidence of SCFE has been reported as 4 times higher in African-American children than in white children and 2.5 times higher in Hispanic children than in white children.[9]

geographic region

In the US, geographic region may be an epidemiological factor, with higher reported incidence rates in the northeast and west than in the midwestern and southern regions.[9]

prior radiotherapy

Also a risk factor for SCFE.[17]

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