Slipped Capital Femoral Epiphysis
What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects children. In SCFE, the head, or “ball,” of the thigh bone (referred to as the femoral head) slips off the neck of the thigh bone. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. This condition causes the hip joint to become painful and stiff.
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Approximately one half of SCFE cases affect both hips, and boys are affected twice as often as girls. SCFE is the most common adolescent hip disorder. It can result from trauma, also referred to as an “acute slip,” or can occur over a period of weeks to years. This is called a “chronic slip.”
SCFE has three degrees of severity:
- mild – approximately one-third of the femoral head slips off of the thigh bone (See A.)
- moderate – approximately one-third to one-half of the femoral head slips off of the thigh bone (See B.)
- severe – more than one-half of the femoral head slips off of the thigh bone (See C.)
What causes slipped capital femoral epiphysis?
The cause of SCFE is unknown. Risk factors that increase the likelihood of SCFE include the following:
Risk factors may include:
- medications (such as steroids)
- thyroid problems
- radiation treatment
- chemotherapy
- bone problems related to kidney disease
Who is affected by slipped capital femoral epiphysis?
SCFE is a rare condition and is more likely to occur in boys than girls. Children ages 10 to 18 years are most at risk.
SCFE is typically seen in children 11 to 16 years of age. When the condition is seen in girls, they are usually between 11 to 13 years of age.
SCFE is more prevalent in the northeast region of the United States than in the southwestern states. It is also more prevalent among African-Americans. In many cases, the child is overweight.
What are the symptoms of slipped capital femoral epiphysis?
Symptoms of SCFE typically include complaints of pain in the hip that is aggravated by activity. Sometimes the child will also experience pain in the groin, thigh, or knee area.
In acute slips, the child will complain of immediate pain, limp, or feel like the “leg is giving way.”
The child with a chronic slip usually walks with a limp, complains of hip pain, and reports that rest alleviates the pain. The child may also walk with his/her leg turned outward.
The symptoms of SCFE may resemble other conditions or medical problems of the hip. Always consult your child’s physician for a diagnosis.
How is slipped capital femoral epiphysis diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for SCFE may include:
- x-rays – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- bone scans – a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
- magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- blood tests
The ultimate goal in SCFE is to diagnose the condition early in order to prevent the head of the femur from slipping further off of the thigh bone, thus preventing hip deformity. When the diagnosis of SCFE is made, the child is not allowed to bear weight on the hip. Crutches or a wheelchair may be used.
Treatment of slipped capital femoral epiphysis:
Specific treatment for SCFE will be determined by your child’s physician based on:
- your child’s age, overall health, and medical history
- the extent of the condition
- your child’s tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
The goal of treatment is to prevent the femoral head from further slippage. Treatment usually may include:
- surgery (involving the use of a steel pin to hold the femoral head onto the femur to prevent it from slipping further)
- physical therapy (following surgery, to help strengthen the hip and leg muscles)
Long-term outlook for a child with slipped capital femoral epiphysis:
The more severe the case, the greater the likelihood the child will experience limited hip motion, differences in leg lengths, and further hip problems in adulthood. However, with early detection and proper treatment, a good outcome with few problems is possible.
SCFE is a common hip pathology seen more frequently in boys than girls during the adolescent growth spurt.
There is a mechanical weakening between the met- aphyses of the femoral neck and head causing the epiphysis to slip posteriorly.
It is more common in children with endocrine disorders, with metabolic bone disease and renal disorders. Children with bilateral slips must be evaluated for thyroid and, growth hormone deficiency and renal causes SCFE may vary from mild (early) slip to moderate and complete slip depending on the extent of displacement of epiphysis. SCFE can also be classified as Stable and Unstable slips depending on the ability of the child to bear weight on the affected leg. Any acute, and unstable SCFE requires emergent treatment. Stable slips also need to pinned on an elective basis. Untreated or unreduced SCFE can lead to Avascular Necrosis of the epiphysis, chondrolysis and Femoral-Acetabular impingment leading to early hip arthritis. Severe Slip may required open reduction using the Anterior or Watson-Jones Approach or the Safe-Surgical Hip (GANZ) Dislocation approach.
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SCFE treated with the Ganz Approach
Severe slip in a 11 year old child treated with the Ganz Safe Surgical Hip Dislocation approach.
