Clinical manifestation, diagnosis and initial management of slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease (LCPD)

Musculoskeletal pain is a common complaint in pediatric clinics and non-inflammatory pains are more prominent. SCFE and LCPD are two important and curable disorders and timely diagnosis can improve clinical outcome. SCFE is characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate. It is one of the most common hip disorders of adolescence. Hip pain is a common presenting feature. The classic presentation is that of an adolescent with obesity with a complaint of nonradiating, dull, aching pain in the hip, groin, thigh, or knee, and no history of preceding trauma. However, approximately ۱۵ percent of patients present with isolated thigh or knee pain. Thus, physicians must have a high degree of suspicion to prevent delay in diagnosis, which can worsen prognosis. Radiographic changes may be minimal before the slip occurs and may be best seen with lateral views. Ultrasonography and magnetic resonance imaging (MRI) also can demonstrate characteristic findings. The treatment of SCFE is operative stabilization. Legg-Calve-Perthes disease (LCPD) is a developmental disorder causing avascular necrosis of the femoral head in children, with long-term consequences that can extend into adulthood. Early diagnosis and management in primary care are crucial but challenging. LCPD commonly presents as a painless limp in children aged between ۲ and ۱۴ years, with the diagnosis based on the clinical features and radiographic abnormalities. Diagnosis of LCP demands a high index of suspicion. Initial radiographs are often normal. Early in the course, bone scan shows decreased perfusion to the femoral head, and MRI reveals marrow changes highly suggestive of the diagnosis. Children diagnosed with LCP should be made nonweight bearing and referred to an experienced pediatric orthopedist for management. Treatment is individualised and includes non-operative care to surgery, which attempts to correct anatomical abnormalities and therefore delay the onset of osteoarthritis.