Slipped Capital Femoral Epiphysis (SCFE)
Slipped capital femoral epiphysis (SCFE) is a hip problem that begins when the top of the thighbone – the epiphysis – slips off the top of the thighbone, the femur.
SCFE may develop in one or both legs. In many cases, this is a gradual process, and can occur suddenly.
Causes
No one knows why SCFE may occur. However, some known risk factors are:
Weakness of the growth plate of the femoral head
Experiencing a rapid growth phase
Male gender
Obesity
Falls or other trauma (in addition to other underlying risk factors)
Symptoms
Common symptoms related to SCFE are:
Hip or knee pain
Limping
Limited range of motion
Loss of flexibility
Inability to bear weight on the affected leg
Inability to walk even with crutches
Turning out of the foot
Diagnosis
Your child’s doctor will take a thorough history and perform a physical exam. Your child’s doctor will also evaluate how your child walks, if he/she is able to do so.
To determine if your child has SCFE, our specialists will order a series of X-rays and may order an MRI if he/she needs more information.
Treatment
Surgery is used to prevent the femoral head (or top of the femur bone) from slipping further, and it is usually performed within 24-48 hours after the condition is diagnosed. If the femoral head continues to slip and surgery isn’t performed, problems can develop such as decreased motion at the hip, ongoing pain and premature arthritis.
If your child is unable to walk even with crutches, surgery will be performed within 24 hours of diagnosis as waiting may lead to worse outcomes. If your child is able to mobilize, surgery will be performed typically within 24-72 hours, as the risks for poor outcomes are lower. Surgery typically consists of placing 1 or 2 screws into the femoral head to prevent further slippage.
As there is a risk for the other side to have the same problem, your child’s surgeon may consider placing a screw into the healthy side to prevent that side from slipping. This is typically only considered in very young patients or in patients with other medical problems.
After surgery, your child cannot bear weight on the affected leg for a period of time and will need to use crutches, a walker or a wheelchair. Your child’s doctor will closely follow your child for the next 18 to 24 months, taking X-rays every 6 months to evaluate if there has been any further movement on the affected side and to ensure that the healthy side has not started to slip as well. Your child won’t be able to participate in sports or physical activity for 3-6 months after surgery to help prevent complications.
Possible Complications
A problem called avascular necrosis of the femoral head (or AVN) can occur. AVN occurs when there is a decreased blood flow to the femoral head, which can occur in some slips. Evidence of avascular necrosis on an X-ray cannot be seen until 6–24 months after surgery.
Chondrolysis is another complication that causes loss of cartilage in the hip joint. It can lead to permanent loss of motion, stiffness and pain. It is not common.
Other possible complications include limited hip rotation, decreased hip flexion, femoral acetabular impingement and external rotation of the foot.