Management of Atypical Slipped Capital Femoral Epiphysis

Atypical slipped capital femoral epiphyseal (SCFE) is associated with endocrine or metabolic disorders and radiation therapy. In this review, we use case examples of hyperparathyroidism, hypothyroidism, and growth hormone deficiency, as well as renal osteodystrophy, radiation-induced, and valgus SCFE to inform the nuances of these unusual cases. From this, we learn that routine laboratory screening of “typical” patients with SCFE is not cost-effective. Patients with atypical SCFE are often short in stature, underweight, and present either older or younger than the typical age range of idiopathic SCFE. Patients fitting these criteria should undergo an endocrine workup. While uncommon, prompt recognition of atypical SCFE is crucial, as coordinated care with pediatric subspecialists is necessary. In situ fixation with cannulated screws is the most common fixation method, and bilateral fixation is recommended. Key Concepts: • Patients younger than 10 or older than 16 years of age and patients with height, weight, or BMI below the 50^th percentile should undergo laboratory screening for atypical SCFE. • Patients presenting with a valgus slip should undergo screening labs for atypical SCFE. • Patients presenting with a unilateral SCFE with underlying endocrinopathy, metabolic disorder, or when associated with radiation therapy should undergo bilateral fixation.