What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a hip problem. It starts if the epiphysis (growing end) of the femur (thigh bone) slips from the ball of the hip joint. SCFE may develop in one or both legs.
SCFE usually occurs in children between the ages of 8 and 15 years old. It often happens during a growth spurt. It’s also more common in children who have a family history of SCFE. More boys than girls get SCFE. It’s more common in blacks than whites. Children who have obesity have a much higher risk of getting SCFE.
Symptoms of slipped capital femoral epiphysis
There are two types of slipped capital femoral epiphysis: stable and unstable.
Stable SCFE
A child is considered to have stable SCFE if they can walk with or without crutches. More than 90% of cases of SCFE are stable.
A child who has stable SCFE may first have stiffness in the hip. The stiffness may get better with rest. After a while, the stiffness may turn into a limp. The child may have pain that comes and goes. The pain is often felt in the groin, the thigh, or the knee, and not in the hip itself.
Later, the child may lose some ability to move the involved hip. This leg will usually twist out. It may look shorter than the other leg. The child may not be able to play sports or run. Your child may also have trouble with regular tasks such as bending over to tie shoes. The symptoms may change gradually or rapidly.
Unstable SCFE
A child who can’t walk, even with crutches, has unstable SCFE. Unstable SCFE often happens after a trauma, such as a sports injury or a fall. Falling can also cause a stable SCFE to become unstable.
A child who has unstable SCFE has extreme pain. The pain is similar to what might be felt with a broken bone. The child probably won’t be able to move the injured leg. If you think your child has unstable SCFE, don’t force the leg to move. That could make the thigh bone slip even more.
What causes slipped capital femoral epiphysis
Doctors don’t know the exact cause of SCFE.
How is slipped capital femoral epiphysis diagnosed?
Your child’s doctor will talk with you and your child about their symptoms. The doctor may watch your child’s gait (how they walk). Your doctor may order X-rays of your child’s pelvis and thigh.
Can slipped capital femoral epiphysis be prevented or avoided?
If your child is severely overweight, losing weight may help reduce the chance of getting SCFE.
Slipped capital femoral epiphysis treatment
Once SCFE is diagnosed, treatment is needed right away. That usually means surgery. Your doctor will probably refer your child to an orthopedic surgeon. This is a doctor who fixes bone problems.
The most common surgery of SCFE is called in-situ fixation. With this treatment, the bone is held in place with a screw. This screw keeps the thigh bone from slipping and will close the growth plate. This usually works for children with stable SCFE. The results of this treatment are good, and it has few complications.
Other surgical treatments (including in-situ fixation with more than one screw) are used less often. Ask your doctor to explain the potential benefits and risks of the treatment options.
Living with slipped capital femoral epiphysis
If SCFE is caught early, there is a good chance for full recovery, especially if it is stable. Research suggests that 30% to 60% of children diagnosed with SCFE will have it occur later in the other leg. This means close follow up and monitoring are important. Sometimes surgery is done to prevent this from occurring. Some children who have had SCFE may get arthritis in the hip later in life.
If your child has surgery, it will take time to get better. For 4 to 6 weeks after surgery, your child will need to use crutches to walk. Then your child can slowly get back into normal activities. They may be able to return to running and contact sports.
Complications sometimes happen with SCFE. The most serious complications are avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of cartilage). Your doctor can explain these issues to you, if needed.
Questions for your doctor
- What is the likely cause of my child’s hip problems?
- Is my child’s SCFE stable or unstable?
- Will my child need surgery?
- What risks are associated with surgery?
- How long will my child need to be on crutches?
- Will my child need physical therapy?
- Are other treatment options available?
- Is my child likely to have SCFE in both hips?
- When can my child return to sports? What kind of exercises are ok?
