Slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE) is a condition in which the femoral head ("ball" at the top of the thighbone) has slipped through the growth plate of the femoral head. (It may help to picture a scoop of ice cream slipping off of a cone.) This problem can be very serious if not treated. Your child will likely be referred to an orthopedist (doctor specializing in treating bone and joint problems) for urgent evaluation and treatment.

Causes

In some cases, SCFE occurs suddenly due to an injury or trauma. In other cases, it develops slowly over time due to an underlying problem. Risk factors (things that make someone more likely to have SCFE) include:

• Being between ages 8 and 15
• Being a boy (more boys than girls have this condition)
• Being African-American
• Being overweight
• Having a problem with the thyroid gland
• Taking certain medications (such as oral steroids or growth hormones)

Symptoms

Symptoms of SCFE include:

• Walking with a limp
• Pain in the hip that may get worse with activity
• Complaints that the hip feels like it's "giving way"
• Walking with the leg turned outward
• Pain in the knee or thigh
• Unable to bear weight

Diagnosis

SCFE is often diagnosed by examining the child and watching him or her walk. An imaging test such as an X-ray is done to confirm the diagnosis. In some cases, additional imaging studies such as an MRI may be needed. Other tests may be done to check for an underlying problem (such as a thyroid problem) that could cause the SCFE.

Treatment

Treating SCFE is considered urgent because further slipping could damage the hip joint. To prevent further slipping, the child may be admitted to the hospital right away for surgery or instructed to use crutches and not put any weight on the leg until the SCFE can be repaired. Surgery is often done within a day or two of diagnosis. During the surgery, the surgeon puts a steel screw through the thighbone into the femoral head. This screw holds the femoral head firmly in place.

What happens after surgery?

• After surgery to fix SCFE, the child will need to walk with crutches for six to eight weeks.
• The child may be referred to a physical therapist for treatment during recovery.
• Follow-up is essential every three to four months for the next two years to recheck the treated hip.
• In a child with SCFE in one hip, the normal hip may be at increased risk of slipping. This is especially true if an underlying problem led to the SCFE, or if the child is younger than 10. In these cases, the surgeon may recommend pinning the normal hip along with the slipped hip. This prevents problems in the future.