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Slipped capital femoral epiphysis

Slipped capital femoral epiphysis

Description

Slipped capital femoral epiphysis (SCFE) is a disorder typically seen in preteens where the head of the hip ball slips off the neck of the hip bone. A common analogy is thinking of the ice cream falling off the cone. This can present as severe hip or knee pain with stiffness, or can present with a gradual onset of symptoms. There are two types of SCFE, stable and unstable. A stable slip is when the child can walk or bear weight on the affected hip. An unstable slip is more severe and the patient is typically unable to walk due to severe pain.

Symptoms

Children with stable SCFE usually present with intermittent pain in the groin, hip, knee and/or thigh for several weeks or months. The pain often worsens with activity and may lead to a limp.

In unstable SCFE, symptoms may include:

  • Rapid onset of pain, frequently after an injury or fall
  • Unable to walk or bear weight on the affected leg
  • Outward turning of the affected leg
  • Leg length discrepancy

Evaluation

With the child laying down, the physician will conduct a physical examination of the affected hip and leg to look for:

  • Pain with motion
  • Limited range of motion

The physician will also order X-rays of the pelvis, hip and thigh from various angles. To confirm a diagnosis, he or she is looking for the X-ray to show that the head of the thighbone appears to be slipping off the neck of the bone.

Treatment

Once the diagnosis is confirmed, the child will not be permitted to bear weight on the affected hip, and in most cases, surgery will usually be performed within 72 hours. The severity of the slip will determine the surgical recommendation. Procedures used to treat SCFE include:

  • In situ fixation

    This is the most common procedure for patients with stable or mild SCFE. The physician will make a small incision near the hip and insert a metal screw across the growth plate to maintain the position of the femoral head and prevent further slippage.

  • Open reduction

    With unstable SCFE, the physician will make an open incision in the hip and then manipulate the femoral head back into its normal position. He or she will then insert one or two metal screws to hold the bone in place until the growth plate closes. This procedure is more involved and has a longer recovery time.