LCCN 2010934377. OCLC 695388693, 771366370, 724696022. (subscription required)
Because the physis has yet to close, the blood supply to the epiphysis still should be derived from the femoral neck; however, this late in childhood, the supply is tenuous and frequently lost after the fracture occurs. Manipulation of the fracture frequently results in osteonecrosis and the acute loss of articular cartilage (chondrolysis) because of the tenuous nature of the blood supply. Diagnosis
The diagnosis is a combination of clinical suspicion plus radiological investigation. Children with a SCFE experience a decrease in their range of motion, and are often unable to complete hip flexion or fully rotate the hip inward. 20–50% of SCFE are missed or misdiagnosed on their first presentation to a medical facility. SCFEs may be initially overlooked, because the first symptom is knee pain, referred from the hip. The knee is investigated and found to be normal. The diagnosis requires x-rays of the pelvis, with anteriorposterior (AP) and frog-leg lateral views. The appearance of the head of the femur in relation to the shaft likens that of a "melting ice cream cone", visible with Kleins line. The severity of the disease can be measured using the Southwick angle. Classification
Atypical/Typical
Loder classification
Stable
Unstable, practically defined as when the patient is unable to ambulate even with crutches
Temporal
Acute
Chronic
Acute-on-chronic
Radiological
Grade I = 0–33% slippage
Grade II = 34–50% slippage
Grade III = >50% slippage

Treatment
The disease can be treated with external in-situ pinning or open reduction and pinning. Consultation with an orthopaedic surgeon is necessary to repair this problem.