Slipped Capital Femoral Epiphysis (SCFE)
What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a disorder of the hip that can happen in your pre-teen or teen. SCFE happens when the head (“ball” part) of the top of the thigh bone (femur) slips backward and downward at the point of growth plate.
Normal hip with femur head and neck fully intact.
The growth plate is where new bone forms. It’s located in the ‘neck’ area of the femur 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. It’s a weaker area than the rest of the bone during the adolescent years when there’s rapid bone growth. When the head of the femur slips, it changes the normal alignment of these sections of the bone.
SCFE can occur in one or both of your child’s hips and develops gradually. It can also occur suddenly due to a fall or other injury.
Are there different types of slipped capital femoral epiphysis?
There are two types of SCFE, stable and unstable.
- Stable SCFE: With this type, your child can still walk. He or she will usually have a limp that comes and goes. It’s worse with activity and gets better with rest. Stable SCFE can cause pain or stiffness in the hip, groin or knee.
- Unstable SCFE: This type is more severe. Your child will not be able to put weight on the affected leg. This type tends to happen suddenly and is more painful. It can also lead to more serious complications.
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 and Hispanic children than Caucasians. It is also more likely to occur in children going through rapid growth spurts.
How common is slipped capital femoral epiphysis?
SCFE is the most common hip disorder in adolescents. It occurs in 11 per 100,000 pre-teens/teens.
Symptoms and Causes
What causes slipped capital femoral epiphysis?
The exact cause of slipped capital femoral epiphysis (SCFE) is not known. However, researchers have identified certain factors or associations that increase the risk of developing SCFE. These include:
- Being overweight.
- A fall or other injury to the hip-thigh area.
- Endocrine disorders including osteodystrophy (defective bone development), hypothyroidism, hyperthyroidism, hypopituitarism and growth hormone deficiency.
- Renal (kidney) disorders (because they affect calcium, a building block of bone).
- Family history of SCFE.
What are the symptoms of slipped capital femoral epiphysis?
Symptoms of slipped capital femoral epiphysis include:
- Pain in your teen’s groin, knee or hip.
- Stiffness in your teen’s hip.
- Foot/leg that is turned outward.
- Walking with a limp.
- Can’t put weight on the leg (usually in more severe cases and with extreme pain).
- One leg may look shorter than the other.
Symptoms can be present for a couple weeks up to four or five months before a diagnosis is made.
Diagnosis and Tests
How is slipped capital femoral epiphysis diagnosed?
SCFE is diagnosed through physical exam including rotation of the affected leg, observation while walking and X-rays. A MRI may be ordered if the diagnosis is not able to be made with X-rays and your healthcare provider still suspects your child has SCFE. Your provider may also order blood work to check for other medical conditions.
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.
How soon is surgery for slipped capital femoral epiphysis needed?
Surgery is performed as soon as possible because the condition can continue to worsen. If there is a waiting time until surgery, your teen should rest and keep weight off their affected leg as much as possible by using crutches, a walker or wheelchair. Your provider will also prescribe appropriate pain relief medication.
What complications can happen in my teen with slipped capital femoral epiphysis?
Major complications are avascular necrosis and chondrolysis. Avascular necrosis is a serious complication that happens if your teen’s femoral head has severely slipped. When this happens, the blood supply to the head of the femur is cut off and the hip begins to collapse. This results in rapid and severe osteoarthritis. Reconstructive hip surgery is often needed. Chondrolysis is a condition that happens when there is a sudden and severe destruction of cartilage in the hip joint.
Other complications include the femur growth stops before it normally should, development of SCFE in the other hip and early development of osteoarthritis of the hip.
How long does it take to recover following slipped capital femoral epiphysis surgery?
Your healthcare provider will discuss your child’s expected time to full recovery. It’s unique to each child and depends on many factors including severity of SCFE and type of surgical procedure done. In general, expect that your child will need crutches or a walker for up to about four weeks after surgery for stable SCFE and for at least six to eight weeks for unstable SCFE. Your child will work with a physical therapist to help strengthen leg and hip muscles and improve range of motion. Talk with your provider about when your child can return to normal activities including sports.
Outlook / Prognosis
What's the outlook (prognosis) for my teen with slipped capital femoral epiphysis?
The outlook for your teen with slipped capital femoral epiphysis depends on the cause and the severity of the slip. All teens 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.