Identification and management of unrecognized femoral head epiphysiolysis: a case report

Background: Slipped capital femoral epiphysis (SCFE) is the slippage of the proximal femoral epiphysis on the femoral neck through the epiphyseal plate. This condition is generally observed in male, obese patients during pubertal growth spurts, and it can sometimes be associated with endocrine disorders. Despite its significant incidence in the paediatric population, the diagnosis is frequently delayed which leads to significant worsening of the prognosis. We present a case of SCFE in which the diagnosis was delayed due to a series of confounding factors. Case presentation: We present a case of a 16-year-old boy who came to our rheumatology centre due to persistent limp for several months. Previous investigations aimed to exclude orthopaedic, infectious or inflammatory conditions, apparently revealed nothing significant, so he was referred for a rheumatological evaluation. Upon further investigation, a SCFE was identified and treated surgically with the modified Dunn procedure. Additionally, during the evaluation, endocrinological conditions such as insulin resistance and delayed puberty were discovered. Conclusion: This case shows that, even in the presence of a suggestive medical history and clinical picture, a common diagnosis such as SCFE can be delayed. The delay in this diagnosis is correlated with clinical worsening of the patient and the need for more invasive management. Therefore, SCFE should always be considered in an adolescent boy who starts experiencing a limp or pain in the lower limbs, even if poorly localized, especially because the diagnosis can be quickly made with a pelvic x-ray. Furthermore, it is always important to remember that conditions such as SCFE, can be associated with endocrinological comorbidities.