Practice Easily missed?

Slipped capital femoral epiphysis

BMJ 2009; 339 doi: (Published 06 November 2009) Cite this as: BMJ 2009;339:b4457
  1. N M P Clarke, consultant orthopaedic surgeon,
  2. Tony Kendrick, associate dean for clinical research, professor of primary medical care
  1. 1Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton SO16 6YD
  1. Correspondence to: N M P Clarke ortho{at}
  • Accepted 12 October 2009

Case scenario

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 epiphysis. The typical patient is obese. In a recent case study of 54 patients with this condition, all had body mass indexes in the overweight or obese ranges.1 In boys, accompanying hypogonadism implicates possible endocrine causes.2 A chronic slip is the …

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