Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review

Abstract

Slipped Capital Femoral Epiphysis (SCFE) is an incapacitating orthopedic disease, particularly affecting older children and adolescents and caused by the sliding of the proximal femoral epiphysis on the metaphysis. SCFE has a clinical polymorphism, compounded with a certain diagnostic variability among health practitioners and the relatively high cost of its surgical management contribute to the diagnostic delay observed in most developed countries as well as developing ones. Herein, we report the case of SCFE in an adolescent Cameroonian, with emphasis on its diagnostic and therapeutic challenges in Low and Middle-Income Countries (LMICs), in a bit to improve on timely recognition and management by clinicians in these settings. A 10-year-old girl has presented with unilateral right thigh pain of more than one year duration associated with a limping gait and no fever. Before the referral to our health facility, she consulted several general practitioners in rural areas and pediatricians in the city with no definite diagnosis. On the basis of the clinical and the imaging studies, the diagnosis of stable right SCFE with moderate displacement was made. Under general anesthesia, the patient underwent open reduction and internal fixation with three pins under c-arm fluoroscopy. Clinical and radiological follow-up till one year after surgical intervention were satisfactory. The pins were removed after one year of fixation confirming a good bone fusion in plain x-ray. Her clinical examination and radiological follow-up three years after removal of the pins were satisfactory. The case report illustrates that SCFE often a missed diagnosis in LMICs. This is worrisome because delayed diagnosis may lead to long-term complications such as avascular necrosis and early degenerative joint disease. Although the above case was missed by several clinicians and finally diagnose late, the present case highlights the need for a high index of clinical suspicion in order to timely diagnose and timely manage SCFE to avert potential long-term physical disabilities and psychological trauma in children.