Should be undertaken in patients eight to 15 years of age with new-onset limping and pain in the hip, groin, thigh, or knee (1). Plain x-rays are generally sufficient for the diagnosis of SCFE (2).
The radiographs needed to diagnose types of SCFE are:
- stable SCFE - anteroposterior and frog-leg lateral views of both hips
- unstable SCFE - anteroposterior and cross-table lateral views of the involved side (the uninvolved side should be compared with this due to decreased range of motion of the hip) (1).
The radiographical features of SCFE include:
- Steel sign - a double density at the metaphysic on AP radiography (1)
- widening of the physis (growth plate) when compared to the uninvolved side
- relatively decreased height of the epiphysis
- Klein’s line - a line drawn along the superior edge of the femoral neck should normally intersect the epiphysis, but in SCFE patients the epiphysis falls below this line (1)
Ultrasound can show if an effusion is present but in practice is rarely indicated. CT scans may be indicated if complex surgery is planned and to assess femoral neck anteversion. (3)
Reference:
- Peck DM, Voss LM, Voss TT; Slipped Capital Femoral Epiphysis: Diagnosis and Management. Am Fam Physician. 2017 Jun 15;95(12):779-784.
- Hesper T, Zilkens C, Bittersohl B, et al. Imaging modalities in patients with slipped capital femoral epiphysis. J Child Orthop. 2017 Apr;11(2):99-106
- Georgiadis AG, Zaltz I; Slipped capital femoral epiphysis: how to evaluate with a review and update of treatment. Pediatr Clin North Am. 2014 Dec;61(6):1119-35.