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OVERVIEW

What is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) is a hip problem that 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

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, and the child may have pain that comes and goes. The pain is often felt in the groin, the thigh or the knee, and not necessarily 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. They may not be able to play sports or do simple tasks such as bending over to tie their 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.

CAUSES & RISK FACTORS

What causes slipped capital femoral epiphysis

Healthcare providers don’t know the exact cause of SCFE.

DIAGNOSIS & TESTS

How is slipped capital femoral epiphysis diagnosed?

Your child’s healthcare provider will talk with you and your child about their symptoms. They may watch your child’s gait (how they walk). Your healthcare provider may order X-rays of your child’s pelvis and thigh.

PREVENTION

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.

TREATMENT

How is SCFE treated?

Once SCFE is diagnosed, treatment is needed right away. That usually means surgery. Your healthcare provider may refer your child to an orthopedic surgeon (a doctor who fixes bone problems).

The most common treatment of SCFE is called “in-situ fixation.” With this treatment, the bone is held in place with a single central screw. This screw keeps the thigh bone from slipping and will close the growth plate. The results of this treatment are good. It has few complications.

Other surgical treatments (including in-situ fixation with more than one screw) are used less often. Ask your healthcare provider 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, possibly including running and contact sports.

Complications sometimes happen with SCFE.  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 who have unstable SCFE. Your healthcare provider can explain these issues to you, if needed.