Pediatric Hip Disorders: Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes Disease

Alexa J. Karkenny; Brandon M. Tauberg; Norman Y. Otsuka

doi:10.1542/pir.2017-0197

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Alexa J. Karkenny, MD*
Brandon M. Tauberg, MD*
Norman Y. Otsuka, MD*

^*Montefiore Medical Center and the Children’s Hospital at Montefiore, Bronx, NY

AUTHOR DISCLOSURE
Drs Karkenny and Tauberg have disclosed no financial relationships relevant to this article. Dr Otsuka has disclosed that he is deputy editor of the Journal of the American Academy of Orthopaedic Surgeons. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AP:: anteroposterior
LCPD:: Legg-Calvé-Perthes disease
MRI:: magnetic resonance imaging
SCFE:: slipped capital femoral epiphysis

Practice Gaps

The differential diagnosis for a limping child or adolescent with hip or knee pain is broad. Delayed or missed diagnoses of slipped capital femoral epiphysis and Legg-Calvé-Perthes disease have significant morbidity. Clinicians should understand when to suspect these disorders based on history, examination, and early imaging findings to allow for timely referral to a specialist.
Clinicians should also have a basic understanding of the treatment options and prognosis of these disorders to counsel patients and their families before and during treatment by a specialist.

Objectives

After completing this article, readers should be able to:

Identify the general anatomy relevant to slipped capital femoral epiphysis (SCFE) and Legg-Calvé-Perthes disease (LCPD) pathology.
Recognize the symptoms and physical examination findings of SCFE and LCPD.
Know the basic laboratory values and imaging to order to evaluate for SCFE and LCPD when referring to a specialist.
Differentiate straightforward presentations of SCFE and LCPD.
Understand broad treatment categories and the prognoses of SCFE and LCPD.
Realize the importance of timely referral to a specialist for SCFE and LCPD.

Introduction

Pediatric hip pathology can lead to devastating complications, such as hip instability, early arthritis, and growth abnormalities. Two of the most common pathologies in this age group include slipped capital femoral epiphysis (SCFE) and Legg-Calvé-Perthes disease (LCPD). The importance of early diagnosis is paramount in both of these disorders, to allow for early treatment and attempt to limit the potentially morbid outcomes. Because many of these children will initially present to their pediatrician, recognition and early referral to an orthopedic …