Slipped Capital Femoral Epiphysis (SCFE) vs. Legg-Calvé-Perthes Disease (LCPD)

Slipped Capital Femoral Epiphysis (SCFE)

• Displacement of the femoral head (epiphysis) posteriorly and inferiorly relative to the femoral neck at the growth plate.
  • Due to mechanical failure
• Epidemiology:
  • Typically affects adolescents (ages 10-16)
  • Obese or rapidly growing children
  • More common in boys
• Risk Factors:
  • Obesity
  • Endocrine disorders (e.g., hypothyroidism, GH deficiency)
• Clinical Presentation:
  • Groin, hip, thigh, or referred knee pain
  • Limp
  • Affected leg often held in external rotation
    • Leg may appear shortened and externally rotated
    • Pain with internal rotation
  • ↓ Internal rotation, abduction, and flexion of the hip
• Diagnosis:
  • X-ray: AP and frog-leg lateral pelvis
  • Klein’s line: does not intersect femoral head
• Treatment:
  • Urgent surgical pinning of the femoral head (even if stable)
  • Non–weight bearing prior to surgery

Legg-Calvé-Perthes Disease (LCPD)

• Idiopathic avascular necrosis of the femoral head due to compromised blood supply
• Epidemiology:
  • Usually affects children aged 4-8 years
  • More common in boys
  • Often small for age, thin, or with delayed bone age
• Risk Factors:
  • Low birth weight
  • Passive smoke exposure
  • Coagulopathies (rare)
• Clinical Presentation:
  • Painless limp or mild hip pain
  • Pain may refer to knee
  • Gradual onset over weeks to months
• ↓ Abduction and internal rotation of the hip
• Trendelenburg gait (late)
• Diagnosis:
  • X-ray: AP and frog-leg views
  • Early: may appear normal → later shows flattening, sclerosis, fragmentation of femoral head
• Treatment:
  • Conservative: activity restriction, NSAIDs, physical therapy
  • Surgery if severe or if >8 years old with extensive involvement
• Prognosis:
  • Good if diagnosed early and well-managed
  • May lead to femoral head deformity and early osteoarthritis

• SCFE = “Obese teen with knee pain and limp, limited internal rotation”
• LCPD = “Young child with painless limp, insidious onset”

SCFE = "Slips in Chubby Fatty Epiphysis"
LCPD = "Little Child’s Poorly Developed femoral head"