Slipped Capital Femoral Epiphysis (SCFE)

Slipped capital femoral epiphysis (SCFE) happens when the round top of your child’s thigh bone slides out of alignment with the rest of their bone. This causes it to fit poorly in their hip socket. It will affect how they walk.

“Epiphysis” is the medical name for the rounded head of a bone. “Femur” is the medical name for your thigh bone. And “capital” refers to the upper epiphysis. So, “slipped capital femoral epiphysis” describes the problem: The top part of your child’s thigh bone has slipped out of place.

SCFE happens during adolescent development. Adolescence is a time of rapid growth, including your child’s bones. Long bones, like your thigh bones, grow new tissue from the growth plate at their rounded end. This new bone tissue starts as cartilage. At this point, it’s softer and weaker than fully formed bone tissue. SCFE can happen when new growth at the end of your child’s femur hasn’t hardened into normal bone yet. The top of your child’s femur is more likely to slip because it bears the weight of their pelvis.

Your child will need surgery to fix slipped capital femoral epiphysis.

Types of SCFE

Healthcare providers classify a slipped capital epiphysis as either stable or unstable.

• Stable SCFE: This means your child can still put weight on their hip. Most children have a stable SCFE hip that develops gradually.
• Unstable SCFE: This is when the slipped epiphysis is very far out of alignment. It causes severe pain. Your child won’t be able to walk or put any weight on that hip. An unstable SCFE hip needs urgent treatment.

Symptoms of slipped capital femoral epiphysis

SCFE usually develops gradually over time. It may start in one hip and then affect the other one later on. It worsens with time, and further complications can occur.

You and your teen may not be quite sure when SCFE first starts. Some of the signs and symptoms can include:

• Hip pain
• Groin pain
• Leg pain
• Knee pain
• Limping or walking unusually
• Stiffness that gets worse while walking
• Difficulty putting weight on one leg
• Difficulty running or bending at the hips
• One hip and leg turned outward
• One leg looks shorter than the other

Slipped capital femoral epiphysis causes

There usually isn’t one single cause of SCFE. Quickly developing bones and weakness at the growth plate set the stage for it. But many other factors may contribute, including:

• Childhood obesity: Most teens with SCFE have a BMI over the 95th percentile for their age.
• Growth spurts: SCFE often occurs during a growth spurt.
• Hormones: Both puberty and obesity can affect your child’s hormone levels. This can impact the growth and strength of their bones. Certain endocrine disorders may also be involved.

Risk factors

Slipped capital femoral epiphysis usually develops between the ages of 11 and 16. It’s slightly more common in males.

Other risk factors include:

• Injuries: A fall or blow to your child’s hip might start the slipping process. Or make it worse.
• Hip abnormalities: Issues like hip dysplasia can add stress to their joints.
• Genes: Having a biological family history of SCFE increases your child’s risk.

Complications of this condition

A slipped epiphysis changes how your child moves their body. It puts extra weight and stress on parts of their hip joint that shouldn’t. This can damage their joint over time. It can lead to:

• Hip impingement: This is painful pinching or rubbing inside your child’s hip joint. It happens when the bones in their hip don’t fit together as they should.
• Avascular necrosis: Too much stress or pressure on a slipped capital epiphysis can cut off the bone’s blood supply. This can lead to bone tissue death.

How doctors diagnose this condition

A healthcare provider will diagnose slipped capital femoral epiphysis with a physical exam and tests. They’ll examine your child’s hip and ask about their symptoms. Your provider will gently move your child’s hip in different ways to see what happens. They’ll follow up with X-rays or an MRI to confirm the slipped epiphysis.

SCFE treatment

SCFE treatment always involves surgery. It’s important to realign and stabilize your child’s hip joint. This will prevent more slipping and complications. There are two main surgical techniques, including:

• In situ fixation: The standard treatment for stable SCFE is a minimally invasive procedure using a technique called arthroscopy.
• Open reduction and internal fixation: For unstable SCFE, a surgeon may have to physically move the head of your child’s thigh bone back into position.

Your teen will have two to three months of recovery and rehab after surgery. They’ll need to use crutches at first. This will keep weight off their hip. When they can use their hip without pain, a physical therapist will give them exercises to regain their strength and flexibility.

Can SCFE heal on its own?

It’s unlikely. A mild case of SCFE can possibly heal without surgery. But this is rare.

It’s possible that your child’s bone self-corrects. But usually, this isn’t possible once SCFE is bad enough to cause symptoms you can notice.

What can I expect if my child has slipped capital femoral epiphysis?

The sooner a healthcare provider diagnoses and treats SCFE, the better. Treating stable SCFE before the femur head slips too much can prevent long-term damage to your child’s hip joint. Surgery at this stage is also simpler and easier to recover from. Most kids recover completely.

Unstable SCFE is rare. And it comes with higher rates of complications. These complications tend to require more extensive surgery. Your child might need joint replacement surgery if they develop hip arthritis.