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Slipped capital femoral epiphysis

Slipped capital femoral epiphysis

What Is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE; pronounced “skiffy”) is a hip condition where the top of the thigh bone slips off the neck of the bone in a backwards direction. This causes pain, stiffness, and instability in the affected hip.

SCFE occurs in teen and pre-teens who are still growing. The condition usually develops gradually over time and is more common in boys than girls. SCFE usually develops during periods of rapid growth, shortly after the onset of puberty. In boys, this most commonly occurs between the ages of 12 and 16; in girls, between the ages of 10 and 14.

The top part of the thigh bone is shaped like a ball (femoral head). It fits into the hip socket. This ball is connected to the straight part of the thigh bone by a growth plate. The growth plate is an area of tissue that, in children, is still developing.

Types of SCFE

  • Stable SCFE: In stable SCFE, the patient is able to walk or bear weight on the affected hip, either with or without crutches. Most cases of SCFE are stable slips.
  • Unstable SCFE: This is a more severe slip. The patient cannot walk or bear weight, even with crutches. Unstable SCFE requires urgent treatment. Complications associated with SCFE are much more common in patients with unstable slips.

SCFE usually occurs on only one side; however, in up to 40% of patients (particularly those younger than age 10) SCFE will occur on the opposite side, as well – usually within 18 months.

Symptoms of SCFE

  • Problems walking
  • Limping
  • Mild pain in the hips, groin or around the knees
  • Severe pain that makes children stop putting weight on the leg that hurts
  • Stiffness in the hip
  • Less movement than usual in the hip
  • One leg may be slightly longer than the other
  • Involuntary muscle guarding and muscle spasms

Treatment for SCFE

Almost all children with the condition have surgery. An unstable SCFE is serious because it can restrict blood flow to the hip joint, leading to death of tissue in the head of the femur. SCFE is treated with surgery to stabilize the bone that has slipped. But even before the surgery, the doctor will try to prevent any further slippage by recommending rest and the use of crutches to avoid putting weight on the affected leg. Often, once the SCFE is discovered, patients are admitted to the hospital to ensure that they rest and that treatment is done as soon as possible.

With more mild slips, the surgery is often done as an outpatient procedure, which means a child can leave the hospital the same day or the day after the surgery if there are no complications.

More severe slips may require more extensive surgery and a longer hospital stay. This type of surgery is performed under general anesthesia (when a patient is completely asleep). Using a fluoroscope — a special X-ray machine that produces a real-time image of the hip on a TV screen — as a guide, the surgeon will make a small incision near the hip, then put a metal screw or pin through the bone and the growth plate to hold it in place.

Sometimes the surgeon will stabilize the other side as well, even if it hasn’t slipped yet, just because there is a high risk of that occurring. More severe slips may require more surgery to realign the hip and protect the blood vessels before the pinning is performed.

After SCFE surgery

After surgery, patients are usually allowed to walk with crutches, and only put some of their weight on the affected leg. Patients who have both hips treated generally may need to use a wheelchair for the first couple of weeks after surgery.

When SCFE is detected and treated early, most patients do well. They will likely receive physical therapy to strengthen the hip and leg muscles, and will continue to have follow-up X-rays to monitor the condition. But in most mild cases, further surgery is not needed.

Kids with unstable SCFE, however, do have a greater chance of developing other problems, such as stiff hips, early arthritis, leg length differences or avascular necrosis (where part of the “ball” dies from lack of blood supply). They are also more likely to require additional surgery to realign the hips as they grow.

Preventing SCFE

Of course, there’s no way to prevent SCFE in every child. But one thing parents can do to lessen the risk is to encourage kids to keep their weight in a healthy range. Maintaining a healthy weight can go a long way in sparing kids’ bones and joints from the excess wear and tear that can weaken and damage them. So if you need help figuring out how to get your child started on a safe diet and exercise plan, talk to your doctor.

Risk factors that make someone more likely to develop the condition include:

  • Excessive weight or obesity – most patients are above the 95th percentile for weight
  • Family history of SCFE
  • An endocrine or metabolic disorder, such as hyperthyroidism – this is more likely to be a factor for patients who are older or younger than the typical age range for SCFE (10 to 16 years of age)