Overview

Slipped Capital Femoral Epiphysis (SCFE) is a condition that can occur in teenagers where the growth plate at the head of the thigh bone slips out of place. It is more common in boys and can cause pain, stiffness, and difficulty walking. This article covers the causes, symptoms, diagnosis, treatment, and outlook for SCFE.

 

What is Slipped capital femoral epiphysis (SCFE)?

Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip joint in children and adolescents. It occurs when the growth plate of the femur bone in the hip joint slips, causing the head of the femur to move out of place. This can lead to pain, stiffness, and difficulty walking.

SCFE most commonly affects boys between the ages of 11 and 16 and girls between the ages of 9 and 15, particularly those who are overweight or obese. The exact cause of SCFE is not fully understood, but it is thought to be related to growth spurts during puberty and hormonal changes that affect the strength of the growth plate.

Early diagnosis and treatment of SCFE are important to prevent further complications, such as hip joint damage, arthritis, and deformity. Children and adolescents who are at risk for SCFE should be regularly monitored by a healthcare provider to detect any signs or symptoms of the condition.

 

Are there different types of Slipped Capital Femoral Epiphysis?

Yes, there are different types of slipped capital femoral epiphysis (SCFE), which are classified based on the severity of the slip and the direction in which the femur bone has shifted. The three main types of SCFE are:

1. Stable SCFE: In this type of SCFE, the femur bone has shifted slightly and is still in contact with the hip socket. The patient may experience mild pain and limping, but the hip joint remains stable.
2. Unstable SCFE: This type of SCFE is more severe, with the femur bone slipping completely out of the hip socket. The patient may experience severe pain and inability to bear weight on the affected leg.
3. Acute SCFE: This type of SCFE occurs suddenly and is usually due to a traumatic injury, such as a fall or sports injury. The patient may experience sudden, severe pain and difficulty moving the affected leg.

In addition to these types, there are also subtypes of SCFE that are based on the angle and direction of the slip, such as anterior or posterior slips. The severity of the slip and the type of SCFE will determine the course of treatment and the potential long-term outcomes for the patient.

 

How common is Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) is a relatively rare condition, but it is the most common hip disorder in children and adolescents. The incidence of SCFE varies depending on the population studied and the criteria used for diagnosis, but it is estimated to occur in about 10 out of every 100,000 children in the general population.

SCFE is more common in boys than girls, and it is most commonly diagnosed in overweight or obese children between the ages of 11 and 16. Children and adolescents with certain medical conditions, such as hypothyroidism or growth hormone deficiency, may also be at increased risk for SCFE.

Because SCFE can cause long-term complications such as hip joint damage and arthritis, it is important for healthcare providers to be aware of the risk factors and to screen for the condition in at-risk populations. Early diagnosis and treatment can improve outcomes and reduce the risk of complications.

 

Who is at risk for developing Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) most commonly affects children and adolescents between the ages of 11 and 16, and it is more common in boys than girls. However, it can occur in younger children and older adults as well.

The following are some of the risk factors for developing SCFE:

1. Age and gender: SCFE is more common in boys and during the growth spurts of puberty.
2. Weight: Children and adolescents who are overweight or obese are at increased risk for SCFE.
3. Endocrine disorders: Certain endocrine disorders, such as hypothyroidism or growth hormone deficiency, can increase the risk of SCFE.
4. Family history: There may be a genetic component to SCFE, as it can run in families.
5. Radiation exposure: Children who have received radiation therapy to the pelvic area may be at increased risk for SCFE.

 

What causes slipped capital femoral epiphysis?

The exact cause of slipped capital femoral epiphysis (SCFE) is not fully understood, but it is thought to be related to a combination of factors, including:

1. Growth spurts during puberty: Rapid growth during puberty can cause the bones to grow faster than the muscles and ligaments, which can put extra pressure on the growth plate of the femur bone in the hip joint.
2. Hormonal changes: Hormonal changes that occur during puberty can affect the strength and stability of the growth plate, making it more susceptible to slipping.
3. Weight: Excess weight or obesity can also put extra stress on the growth plate and increase the risk of SCFE.
4. Genetics: There may be a genetic component to SCFE, as it can run in families.
5. Radiation exposure: Children who have received radiation therapy to the pelvic area may be at increased risk for SCFE.

SCFE can occur suddenly, such as in cases of trauma, or it can develop gradually over time. The exact cause may vary depending on the individual case, but it often involves a combination of the above factors. Early diagnosis and treatment are important to prevent further slipping and long-term complications.

 

What are the symptoms of Slipped Capital Femoral Epiphysis?

The symptoms of slipped capital femoral epiphysis (SCFE) can vary depending on the severity of the slip and the duration of the symptoms. Some common symptoms include:

1. Pain in the hip, groin, thigh or knee: This is often the first symptom of SCFE and may be mild or severe. The pain may worsen with activity and may be felt on the inside of the affected hip or thigh.
2. Limping: The pain and discomfort of SCFE may cause the child to limp or have difficulty walking normally.
3. Limited range of motion: The child may have difficulty moving the affected hip joint and may feel stiffness or decreased mobility.
4. External rotation of the leg: The affected leg may turn outward or away from the body due to the slipping of the femur bone.
5. Differences in leg length: The affected leg may appear shorter than the other leg.

 

How is Slipped Capital Femoral Epiphysis diagnosed?

Slipped capital femoral epiphysis (SCFE) can be diagnosed through a combination of physical examination, medical history, and imaging tests. The following are some of the diagnostic methods used:

1. Physical examination: The doctor will perform a physical exam to check for pain, stiffness, and limited range of motion in the hip joint. The doctor may also check for differences in leg length and external rotation of the affected leg.
2. X-ray: An x-ray of the hip joint can show the degree of slipping and help determine the severity of the condition. X-rays may also be taken of the other hip joint to compare the degree of slipping and to rule out other conditions.
3. MRI: Magnetic resonance imaging (MRI) may be used to provide a more detailed view of the hip joint and surrounding soft tissues.
4. CT scan: A computed tomography (CT) scan may be used to provide a more detailed view of the bones and soft tissues in the hip joint.

Once a diagnosis of SCFE is confirmed, the doctor may also order blood tests or other imaging tests to rule out other conditions or to assess the extent of the slipping.

Early diagnosis and treatment of SCFE is important to prevent further slipping and to reduce the risk of long-term complications such as arthritis and hip joint damage.

 

How is Slipped Capital Femoral Epiphysis treated?

The treatment for slipped capital femoral epiphysis (SCFE) typically involves surgery to stabilize the affected hip joint and prevent further slipping of the femur bone. The specific type of surgery and the approach may vary depending on the severity of the slipping, the age and overall health of the child, and other factors. The following are some of the common treatment options for SCFE:

1. In-situ pinning: In this procedure, the surgeon will use metal pins or screws to stabilize the growth plate and prevent further slipping. This is typically performed for mild to moderate cases of SCFE.
2. Open reduction and internal fixation: For more severe cases of SCFE, an open surgery may be needed. This involves making an incision in the hip joint to realign the femur bone and stabilize it with screws or pins.
3. Osteotomy: In some cases, a surgeon may recommend an osteotomy, which involves cutting and repositioning the bone to improve alignment and stability.
4. Rehabilitation: After surgery, the child will need to undergo rehabilitation, which may include physical therapy and exercises to improve strength, flexibility, and range of motion in the hip joint.

In some cases, if the slipping is caught early, the surgeon may be able to stabilize the hip joint with a brace or other non-surgical methods. However, surgery is typically needed to prevent further slipping and reduce the risk of complications such as avascular necrosis (death of bone tissue due to lack of blood supply), arthritis, and hip joint damage.

 

How soon is surgery for Slipped Capital Femoral Epiphysis needed?

The timing of surgery for slipped capital femoral epiphysis (SCFE) depends on several factors, including the severity of the slipping, the age and overall health of the child, and the risk of complications. In general, surgery is recommended as soon as possible to prevent further slipping of the femur bone and reduce the risk of complications.

If the slipping is caught early, the doctor may recommend non-surgical treatment such as rest, using crutches, and avoiding weight-bearing activities on the affected leg. However, if the slipping is severe or progressive, surgery may be necessary to stabilize the hip joint and prevent further damage.

In some cases, if the slipping is unstable or rapidly progressing, surgery may be performed on an emergency basis to prevent further damage and reduce the risk of complications such as avascular necrosis (death of bone tissue due to lack of blood supply), arthritis, and hip joint damage.

 

What complications can happen in my teen with Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) can lead to several complications, especially if it is not treated promptly and effectively. Some of the potential complications include:

1. Avascular necrosis: SCFE can disrupt the blood supply to the hip joint, which can lead to avascular necrosis (AVN) or death of bone tissue. This can cause pain and limit mobility in the hip joint.
2. Hip joint damage: Continued slipping of the femur bone can cause damage to the hip joint, including cartilage damage, labral tears, and joint instability. This can lead to arthritis and chronic pain.
3. Leg length discrepancy: If SCFE affects both sides of the hip, it can cause a difference in leg length, which can affect gait and lead to back pain and other issues.
4. Chondrolysis: In rare cases, the cartilage in the hip joint can break down and deteriorate after surgery, a condition known as chondrolysis.
5. Delayed diagnosis and treatment: Delayed diagnosis and treatment of SCFE can lead to worsening symptoms, increased risk of complications, and permanent damage to the hip joint.

 

How long does it take to recover following Slipped Capital Femoral Epiphysis surgery?

The recovery time following surgery for slipped capital femoral epiphysis (SCFE) varies depending on the severity of the condition, the type of surgery performed, and the overall health of the patient. In general, recovery can take several weeks to several months.

After surgery, your teen may need to use crutches or a walker for several weeks to avoid putting weight on the affected leg. Physical therapy may also be recommended to help your teen regain strength, mobility, and range of motion in the affected hip and leg. The physical therapy program may include exercises to improve flexibility, strength, and balance, and to reduce pain and swelling.

Your teen's doctor will provide specific instructions on how to care for the surgical site, including wound care and dressing changes, and when to follow up with the doctor. It is important to follow all post-operative instructions carefully to ensure proper healing and prevent complications.

Most teens can return to school within a few weeks of surgery, although they may need to avoid sports and other physical activities for several months. It is important to avoid high-impact activities that could put stress on the affected hip joint, as this can increase the risk of complications such as avascular necrosis and hip joint damage.

Your teen's doctor will monitor their progress and provide guidance on when it is safe to resume normal activities. In general, it is important to be patient during the recovery process and to follow all recommendations from the medical team to ensure the best possible outcome for your teen.

 

What's the outlook for my teen with Slipped Capital Femoral Epiphysis?

The outlook for teens with slipped capital femoral epiphysis (SCFE) varies depending on the severity of the condition, the type of treatment received, and other individual factors such as age, overall health, and the presence of any underlying medical conditions.

With prompt diagnosis and appropriate treatment, most teens with SCFE can recover fully and return to normal activities. However, some teens may experience long-term complications such as hip joint damage, arthritis, or avascular necrosis (AVN) that can lead to chronic pain and mobility problems.

The outcome of SCFE depends on several factors, including the severity of the condition at the time of diagnosis, the degree of slippage, and the effectiveness of the treatment. Teens with mild to moderate SCFE typically have a better prognosis than those with severe or unstable slips.

Following treatment, your teen may need ongoing monitoring to assess their hip joint health and identify any potential complications. This may involve regular follow-up visits with their doctor, periodic imaging studies such as X-rays or MRI, and ongoing physical therapy.

 

Conclusion 

Slipped capital femoral epiphysis (SCFE) is a condition that can occur in teenagers where the growth plate at the head of the thigh bone slips out of place. It is more common in boys and can cause pain, stiffness, and difficulty walking. If left untreated, SCFE can lead to serious complications, such as hip joint damage and avascular necrosis.

Prompt diagnosis and treatment are crucial for a good outcome. Treatment typically involves surgery to stabilize the growth plate and prevent further slippage. After surgery, most teens require a period of recovery and physical therapy to regain strength and mobility.