The Hip Fracture that Feels like Knee Pain in Children and Teens

April 22, 2016 in Our News & Bulletins by Integrity Rehab

All students who see a healthcare provider for unexplained knee pain should have a hip examination as well. Slipped capital femoral epiphysis (SCFE) ranks as one of the most important hip disorders in pre-adolescents and early teens, and it often presents as knee pain and intermittent limping. Even though parents often let this pain go for months, hoping it will self-resolve, when diagnosed, it requires immediate surgery. Recognizing this tricky hip problem early and seeking appropriate attention can prove crucial in protecting the long-term health and function of a child.

SCFE occurs when the ball at the upper end of the thigh bone (the femoral head) slips backwards from its correct position relative to the rest of the thigh bone, and the femoral head positions lower in the hip (more specifically it positions inferiorly in the acetabulum). The condition develops during periods of accelerated growth, and is thought to be related to weakness of the growth plates. Slipping of the epiphysis is usually a slow gradual process, but it can also occur suddenly or be associated with a minor fall. Pain can be so severe that a child cannot bear any weight on the leg, but months of nagging pain with intermittent limping is the more normal presentation. The pain can be in the hip, thigh, and/or knee. In cases of knee pain, the hip displacement is referring pain to the knee via the obturator nerve. The affected leg may sometimes rotate outwards and appear shorter.

Coaches and parents need to recognize SCFE and/or get an assessment quickly. If allowed to persist, SCFE can result in permanently restricted motion in the joint. When SCFE is diagnosed, surgery should occur within two days. Rehabilitation should follow. A physical therapy assessment consists of a careful history, range of motion testing, and gait assessment. The surgeon can confirm the diagnosis with X-rays.  After timely surgery, a couple of months of restricted activity, and rehabilitation, outcomes are usually good.

SCFE has a strong hereditary component. The only known modifiable risk factor is maintaining a healthy weight.

Hip Fracture Children