Slipped Capital Femoral Epiphysis (SCFE) β A High-Yield UKMLA/PLAB Scenario (February 2025 Exam Theme) π¦΅
Essential Insights for Medical Licensing Exams: Recognising SCFE and Its Emergency Management
Slipped Capital Femoral Epiphysis (SCFE), also known as Slipped Upper Femoral Epiphysis (SUFE) in the UK, is an orthopaedic emergency that requires prompt diagnosis and immediate surgical intervention. This article breaks down a high-yield paediatric orthopaedic scenario that is commonly tested, covering the latest NICE guidelines on hip pain in children. Understanding SCFE management is crucial for UKMLA, PLAB, and other medical licensing exams.
π Case Scenario
A 14-year-old boy presents to the Emergency Department with a 2-day history of worsening right hip pain. The pain started after getting out of bed and has gradually worsened. He is unable to bear weight and his parents report a recent change in his walking pattern, describing it as a "waddle."
He is obese, with a BMI in the 98th percentile for his age. On examination, there is restricted internal rotation of the hip, and passive hip flexion results in external rotation of the leg.
X-ray of the pelvis confirms posterior displacement of the femoral head relative to the femoral neck.
What is the most appropriate next step in management?
A) Physiotherapy referral
B) Dietary advice and weight loss counselling
C) Same-day referral to orthopaedics
D) MRI of the hip
E) NSAIDs and close observation
Answer with an explanation is provided below.
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β Correct Answer: C) Same-day referral to orthopaedics
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Clinical Reasoning and Explanation
Clinical Reasoning and Explanation
SCFE occurs when the femoral head slips posteriorly and inferiorly relative to the femoral neck through the growth plate (physis).
π Why This Is SCFE?
β
Age (14 years) β Peak incidence occurs in adolescents aged 10-16
β
Obesity β Major risk factor due to increased mechanical stress on the growth plate
β
Pain with inability to bear weight β Suggests unstable SCFE, requiring urgent stabilisation
β
Waddling gait β Chronic compensatory gait change seen in SCFE
β
Obligatory external rotation with hip flexion β Pathognomonic for SCFE
π₯ Urgent Orthopaedic Referral Is Essential
π SCFE is a surgical emergency if unstable. Delayed treatment increases the risk of:
Avascular necrosis (AVN) of the femoral head π¦΄
Chondrolysis (cartilage degeneration) π¨
Early osteoarthritis and long-term disability
π¨ Immediate management involves:
Non-weight-bearing status (strict bed rest) ποΈ
Urgent hospital admission
Surgical stabilisation with screw fixation π©
β Why the Other Options Are Incorrect
A) Physiotherapy referral
Physiotherapy may be useful after surgery for rehabilitation, but it is not appropriate as an initial step for suspected SCFE, which requires urgent surgical intervention.
B) Dietary advice and weight loss counselling
Although obesity is a risk factor, weight loss advice does not address the acute orthopaedic emergency. Long-term weight management is important, but surgery is the priority.
D) MRI of the hip
Imaging is already diagnostic from the plain X-ray, which is usually sufficient. MRI may be considered in atypical cases or to assess avascular necrosis post-surgery. It is not required initially when plain films confirm SCFE.
E) NSAIDs and close observation
This would be inappropriate as SCFE requires urgent surgical stabilisation, not conservative management. Delaying treatment would increase the risk of permanent damage.
π₯ SCFE Management β UK Guidelines (NICE CKS: Hip Pain in Children)
StepAction
1οΈβ£ Confirm DiagnosisPelvis X-ray (AP + Frog-leg lateral view)
2οΈβ£ Immediate ManagementStrict non-weight-bearing + Urgent orthopaedic referral
3οΈβ£ Surgical FixationSingle screw percutaneous fixation (stabilises epiphysis)
4οΈβ£ Monitor for Bilateral Involvement40% of cases are bilateralβprophylactic fixation may be considered
5οΈβ£ Long-term Follow-UpMonitor for avascular necrosis, chondrolysis, early osteoarthritis
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