Published 6 November 2009, doi:10.1136/bmj.b4457
Cite this as: BMJ 2009;339:b4457

Practice

Easily missed?

Slipped capital femoral epiphysis

N M P Clarke, consultant orthopaedic surgeon, Tony Kendrick, associate dean for clinical research, professor of primary medical care

1 Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton SO16 6YD

Correspondence to: N M P Clarke ortho@soton.ac.uk

The first 150 words of the full text of this article appear below.


A 13 year old boy visited the general practitioner because of a six week history of intermittent limp and pain in the left lower thigh and knee, which was exacerbated by playing sports. On examination he was overweight, but he had no abnormality in the knee. "Knee strain" was diagnosed, and he was advised to take ibuprofen and abstain from sports. Four weeks later he returned with worsening more persistent pain, now in the thigh as well as the knee. Careful examination of the hip elicited a degree of restriction of flexion and rotation, both internal and external, with 2 cm shortening of the affected leg. Radiography of the left hip showed a slipped capital femoral epiphysis.


Slipped capital (or upper) femoral epiphysis occurs during periods of rapid growth in adolescence, when shear forces, particularly in obese children, increase across the proximal femoral growth plate, leading to displacement of the . . . [Full text of this article]


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