• Slipped Capital Femoral Epiphysis

    (SCFE)

    Definition

    Slipped capital femoral epiphysis (SCFE) is a disorder of the hip during adolescence. The ball in the hip joint at the end of the thigh bone slips backward, partially off of the thigh bone. The slipping can occur suddenly or gradually.
    There are 2 types of SCFE:
    • Stable—Generally mild with worsening symptoms that slowly interfere with the ability to walk normally. Nearly all cases of SCFE are considered stable.
    • Unstable—A severe change in position that makes it nearly impossible to bear weight on the affected leg.
    SCFE requires prompt medical treatment to prevent complications and permanent damage.
    The Hip Joint
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    Causes

    The top of the thigh bone has a small ball that fits into a socket in the pelvis to make the hip joint. In children and adolescents, this ball sits just above an area of cartilage that allows the bone to grow, known as the growth plate. With SCFE the ball has slipped off of the growth plate and is in an abnormal position.
    SCFE is caused by excess pressure on the growth plate. The pressure causes the part of the thigh bone just below the growth plate to slip up and forward without moving the ball from the hip socket. It usually occurs during sudden growth spurts common after puberty. Severe slips can damage blood flow to the tissue which can cause death to hip tissue.

    Risk Factors

    SCFE is more common in males and in adolescents who are obese. Other factors that increase the risk of SCFE include:

    Symptoms

    Stable SCFE can progress slowly, resulting in symptoms that worsen over time. Stiffness in the hip eventually gives way to pain, which may cause a limp. Hip pain may occur on one or both sides of the body or be felt in the groin, thighs, or knees.
    Unstable SCFE causes more severe symptoms, such as inability to walk or bear weight on the affected leg. The affected leg may turn outward or appear shorter than the unaffected leg.
    Complications of untreated or unstable SCFE include bone tissue death and osteoarthritis. These complications may be present even after treatment. Symptoms of complications include joint stiffness, pain, and degeneration.

    Diagnosis

    Your child’s doctor will ask about their symptoms and medical history. A physical exam will be done. This will include an evaluation of the hip joint and how it moves. The doctor will observe your child walking to see if their gait is abnormal or how they distribute their weight. The doctor may suspect SCFE based on this information.
    Imaging tests will evaluate the hip joint and surrounding structures. These may include:

    Treatment

    SCFE is treated with a surgical procedure called pinning, usually within a couple of days of diagnosis. Before surgery, crutches or a wheelchair will be needed to keep weight off of the affected leg and decrease further damage. The goal of surgery is to stabilize the joint and prevent any further slipping of the growth plate. This will help prevent complications and permanent damage.
    The type of surgery depends on the severity of the slip. Screws or pins are inserted through the bone and into the head of the thigh bone. In some cases, realignment of the bones (reduction) may be necessary before pinning.
    Prophylactic pinning, surgery on unaffected hip, may be done in those with a high risk for having another slip.

    Prevention

    Most cases of SCFE are caused by obesity. Excess weight puts pressure on the bone and joints, causing damage. Work with your doctor to monitor your child’s weight and develop a plan to reach and maintain a healthy weight.

    RESOURCES

    Kids Health—Nemours Foundation http://kidshealth.org

    Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

    CANADIAN RESOURCES

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    When it Hurts to Move—Canadian Orthopaedic Foundation http://whenithurtstomove.org

    References

    Peck D. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician. 2010;82(3):258-262.

    Slipped capital femoral epiphysis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00052. Updated June 2016. Accessed August 24, 2017.

    Slipped capital femoral epiphysis (SCFE). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115433/Slipped-capital-femoral-epiphysis-SCFE. Updated July 27, 2017. Accessed August 24, 2017.

    Slipped capital femoral epiphysis (SCFE). Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pediatrics/bone-disorders-in-children/slipped-capital-femoral-epiphysis-scfe. Updated February 2017. Accessed August 24, 2017.

    Slipped capital femoral epiphysis (SCFE). Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/scfe.html. Updated September 2016. Accessed August 24, 2017.

    Revision Information

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