Slipped Capital Femoral Epiphysis

What is slipped capital femoral epiphysis (SCFE)?

Slipped Capital Femoral Epiphysis (SCFE) is a common cause of a painful hip in older children and adolescents. It causes pain, limping and sometimes inability to bear weight on the affected side. In some instances, it is found after a prolonged period of knee pain instead of hip pain on the affected side; as a result, delayed diagnosis is not uncommon. The usual age range is between 10 and 16 years. Boys are more affected than girls. The incidence rate in boys is 13.35 per 100,000, whereas the rate in girls is 8.05 per 100,000.

The upper end of the femur (thigh bone) in children and teenagers has a growth plate, which is responsible for the longitudinal growth of the bone. This plate is the weakest part of the bone. Sometimes, the physical stress on the growth plate combines with hormonal and anatomic changes of the hip to produce enough weakness at the growth plate to allow a disruption through the growth plate. We call this condition slipped capital femoral epiphysis. The slip usually occurs over time (chronic); however, it may occur acutely following a fall or minor injury. Occasionally, an acute slip occurs in a hip that has already been slipping chronically (acute on chronic).

What are the two types of slipped capital femoral epiphysis?

There are two types of slipped capital femoral epiphysis: stable and unstable. If the patient can walk or bear weight on the affected side, the slip is stable. It is unstable if the patient cannot walk on the extremity even with crutches. Treatment of an unstable SCFE is an urgent operation to prevent serious complications.

The involvement of both hips at the same time occurs 20% of the time. Sequential involvement of the other hip occurs 20% of the time within 18 months. This is more common in children with significant growth remaining or endocrine abnormalities. Labs are drawn on atypical cases to be certain that an endocrine abnormality is not missed.

What are the risk factors of slipped capital femoral epiphysis?

Some conditions make it more likely that a person develops slipped capital femoral epiphysis:

• Hormonal changes in the body. Growth spurts, for example, are associated with a higher risk of SCFE. Hypothyroidism also increases the risk. Renal failure is also known to predispose to slipped capital femoral epiphysis.
• Obesity
• Some medicines, like steroids
• Chemotherapy or irradiation for cancer treatment, and
• History of slipped capital femoral epiphysis in the family.

What are symptoms and signs of slipped capital femoral epiphysis?

Some symptoms and signs of slipped capital femoral epiphysis are pain, limitation of range of motion of the affected hip, limping, inability to walk (in severe cases), outward turning of the affected limb and shortening of the limb (in unstable cases).

How is slipped capital femoral epiphysis diagnosed?

The orthopedic surgeon can diagnose the slip by taking a thorough history and doing a physical exam aided by X-rays. In rare cases, an MRI or CT scan is necessary.

How is slipped capital femoral epiphysis treated?

The treatment of this condition is always surgery. If the slip is stable, the surgeon will fix the slip with a screw through a small incision on the skin under fluoroscopy, an imaging technique that uses X-rays to show real-time moving images on a monitor during the procedure in the operating room. The screw will pass through the growth plate, and over time, the growth plate will be closed. Thus, no further slippage can occur.

In an unstable case, the surgeon will use a long incision on the skin to reduce the slip by manipulating the femur neck over the femur head and fixing it with screws. Sometimes, it is necessary to also fix the opposite hip to prevent future slip.

Following surgery, patients with a stable slip are able to bear weight immediately. Patients who require open reduction will need to remain non-weight bearing for at least eight weeks to allow initial healing. Regular follow up is in order until X-rays show that the growth plate is fused and there are no complications.

What are possible complications for slipped capital femoral epiphysis?

The most common long-term complication of slipped capital femoral epiphysis is arthritis. This occurs for multiple reasons, and it is most common after severe slips. Chondrolysis and avascular necrosis of the femoral head are less common complications following SCFE. Chondrolysis is rapid degeneration of the cartilage and loss of motion in the hip joint. Avascular necrosis is more common after acute SCFE, occurring up to 50% of the time.

Why choose the International Center for Limb Lengthening for treatment of slipped capital femoral epiphysis?

Doctors who treat slipped capital femoral epiphysis