What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a disorder of the hip that occurs in adolescents. The adolescent years are a time of rapid bone growth. New bone is formed at a specific area of the bone called the growth plate. In thigh (femur) bones, the growth plate is in the ‘neck’ area of the bone between the ‘ball’ section and the long shaft section of the femur. The growth plate is made up of cartilage, which is a soft, flexible layer. Because it is the area where new bone is forming, it is weaker than the rest of the bone. In SCFE, the ‘ball’ section of the femur slips backward at the growth plate. This slip causes a shift in the normal alignment of the ‘ball’ section of the femur and the neck section of the femur.
The disorder can occur in one or both hips and develops gradually. It can also occur suddenly due to a fall or other injury.
Who is at risk for developing slipped capital femoral epiphysis?
Typically, SCFE occurs in overweight children between 11 and 16 years old and is more common in boys than girls. SCFE occurs more frequently in African Americans than Caucasians. It is also more likely to occur in children going through rapid grow spurts.
Symptoms and Causes
What causes slipped capital femoral epiphysis?
Slipped capital femoral epiphysis occurs when the head of the thighbone (femur) slips off the neck of the bone at the growth plate. The growth plate is where new bone forms. It is the weaker area of the bone during the adolescent years when children are still growing. Extra body weight on the bones (from being overweight), rapid growth, a fall or other injury to the hip-thigh area can put an adolescent at risk for developing slipped capital femoral epiphysis.
What are the symptoms of slipped capital femoral epiphysis?
- Pain in the groin, knee or hip
- Stiffness in the hip
- Foot/leg that is turned outward
- Walking with a limp
- One leg may look shorter than the other
In more severe cases, pain can be extreme and the affected leg may not be able to bear any weight.
Diagnosis and Tests
How is slipped capital femoral epiphysis diagnosed?
SCFE can be diagnosed through physical exam, observation while walking, and X-rays.
Management and Treatment
How is slipped capital femoral epiphysis treated?
Surgery is needed. The goal of surgery is to prevent further slippage and avoid complications. The most common type of surgery is called ‘screw fixation.’ In this procedure, the surgeon passes a screw from the side of the top of the femur, through the neck of the femur, through the growth plate and into the ‘ball’ section of the femur. The screw keeps the ‘ball’ section of the femur from slipping out of place.
What complications can occur in patients with slipped capital femoral epiphysis?
Major complications are avascular necrosis and chondrolysis. Avascular necrosis is a serious complication that occurs in patients with severe slippage. When this happens, the blood supply to the head of the femur can be cut off and the hip begins to collapse. This results in rapid and severe arthritis. Reconstructive hip surgery is often necessary. Chondrolysis is a condition that occurs when there is a sudden and severe destruction of cartilage in the hip joint.
Outlook / Prognosis
What's the outlook (prognosis) for a child with slipped capital femoral epiphysis?
The outlook of slipped capital femoral epiphysis depends on the cause and the severity of the slip. All patients are at increased risk of developing osteoarthritis (regardless of the degree of slip). At some point, reconstructive hip surgery may be needed if symptoms -- including hip pain, decrease in range of motion, and stiffness -- continue to worsen over time.