What is a Slipped Capital Femoral Epiphysis, also called SCFE?
Slipped capital femoral epiphysis (SCFE – pronounced “skiffy”) is an unusual disorder of the adolescent hip. In SCFE, the head or “ball” of the thigh bone (referred to as the femoral head) slips off the neck of the thigh bone in a backward direction. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off of the cone. This condition causes the hip to become painful and stiff.
We do know that SCFE is a rare condition and is more likely to occur in boys than girls. Children ages 10 to 18 years old are most at risk. Typically SCFE is seen in children 11 to 16 years of age. In girls, SCFE is usually seen 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.
SCFE has three degrees of severity, and is classified as stable or unstable.
Mild – approximately one-third of the femoral head slips off of the thigh bone.
Moderate – approximately one-third to one-half of the femoral head slips off of the thigh bone.
Severe – more than one-half of the femoral head slips off of the thigh bone.
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. SCFE can result from trauma, also referred to as an “acute slip” or can occur over a period of weeks to years, also referred to as a “chronic slip.”
What causes slipped capital femoral epiphysis?
The cause of SCFE is unknown. Risk factors that increase the likelihood of SCFE include the following:
Medications (such as steroids)
Bone problems related to kidney disease
Growth hormone abnormalities
Family history of SCFE
Is this a problem?
Yes. If left untreated, the head may slip off the thigh bone completely and prevent the individual from being able to walk. If the hip heals in an abnormal shape, the patient can continue to have hip pain, limitations with range of motion, activity limitations, avascular necrosis, and early arthritis.
What are the treatment options?
Once SCFE is diagnosed, surgery is usually the treatment of choice. Surgery is usually done within 24 – 48 hours, as to prevent the head of the femur from slipping further off of the thigh bone, as this may limit hip motion. We do not try to put the bone back is place because this may created a problem with the blood flow to the ball of the hip joint.
The most common treatment of SCFE is called “In-situ fixation.” With this treatment, the bone is held in place with one or two screws. The screws keep the thigh bone from slipping and will close the growth plate. The results of this treatment are good. The screw is a permanent part of your child’s body. The screw is stainless steel and your child should have no trouble with metal detectors.
FAQs about SCFE
What are symptoms of a slipped capital femoral epiphysis?
Some children with SCFE usually complain of pain in the hip that is aggravated by activity. Sometimes the child will also experience pain in the groin, thigh or the knee area.
A child with a stable SCFE may have stiffness in the hip that gets better with rest. After a while, the stiffness may turn into a limp and the child may have intermittent pain.
In later stages, the child may lose some ability to move the involved hip. This leg will usually twist out, and it may look shorter than the other leg. The child may not be able to play sports or do simple tasks such as bending over to tie his / her shoes. Symptoms may change gradually or rapidly.
A child with an unstable SCFE has extreme pain that is similar to what might be felt with a broken bone. The child probably won’t be able to move the involved leg.
How is slipped capital femoral epiphysis diagnosed?
To check for a stable or unstable SCFE, x-rays will be taken that show the pelvis and thigh area from several different angles. Depending on what the x-rays show will depend on the need for further testing. If x-rays are normal, other diagnostic procedures may be required and may include:
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 structures within the body.
The 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 wheelchair may be used.
What are the complications of slipped capital femoral epiphysis?
The most serious complications of SCFE are avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of cartilage). Avascular necrosis is more common in patients with an unstable SCFE.
The risk of these complications increase as the severity of the SCFE increases. This is why it is important to get treatment right away. Evidence of avascular necrosis may not be seen on x-rays for as long as 6 to 24 months following surgery.
When can my child resume normal activities?
Getting better takes time. For four to six weeks after surgery, your child will need to use crutches to walk. Then your child can slowly resume normal activities.
Will my child recover completely?
If the SCFE is caught early enough, there is a very good chance for a full recovery, especially if it is stable. Fast treatment is VERY important. However, some children who have had a SCFE may get arthritis in the hip later in life.