Slipped Femoral Epiphysis

what is slipped capital femoral epiphysis (scfe)?

The hip is a ball and socket joint that connects the thigh bone (femur) to the pelvis (acetabulum). The hip joint is the largest weight bearing joint in the body. The hip joint is surrounded by strong ligaments and muscles.
A Slipped Capital Femoral Epiphysis (SCFE) is a condition where the growing portion of the upper femur gradually slips downwards and backwards while the bones are still growing. It most commonly occurs during growth spurts around the onset of puberty.
In some instances, children are

able to walk and weight bear on the affected hip but they will often complain of pain and will limp. Sometimes the slip is so severe that the child will not be able to walk at all.
Surgical management of SCFE is often required and if your child is complain of hip or knee pain and is unable to walk then urgent medical review is needed.

what are the causes?

Although the causes are unknown, certain risk factors increase the risk of this condition occurring. These risk factors include:

  • More common in boys than girls
  • Most common between the ages of 10 and 16
  • Overweight or obese
  • Family history of slipped femoral epiphysis
  • An endocrine or metabolic disorder such as hypothyroidism

what are the symptoms?

The symptoms of SCFE depend on the severity of the condition.

Mild stable SCFE can cause periods of pain in the hip, groin, knee or thigh that increases with activity.

In more severe and cases of unstable SCFE, the following may be seen:

  • Sudden pain after fall or injury
  • Inability to walk or weight bear
  • Leg rotates outwards
  • Unequal leg length

how is it diagnosed?

The doctor will ask you about your child’s symptoms.

A physical examination of your child’s affected leg will provide the doctor with information on your child’s range of movement that will help determine the diagnosis. The doctor may observe your child walking (if able).

The diagnosis can be confirmed on x-ray where the slipped femur can be viewed.

Occasionally a CT scan and/or an MRI scan may need to be performed prior to surgery.

how is it treated?

A SCFE almost always requires surgery. The procedure generally involves securing the femur in place with metal screws or pins to avoid future slipping.

complications of surgery

Complications of the treatment of SCFE are:

  • Avascular necrosis – this is caused by a disruption in the blood supply to the femoral head resulting in gradual bone collapse. Monitoring for avascular necrosis will occur through x-rays for 12months following the surgery.
  • Chondrolysis – a deterioration of the articular cartilage on the bones in the hip joint that causes permanent loss of motion, pain and deformity. The condition is treated with physiotherapy and anti-inflammatory medication.

recovery

Your child will need crutches to weight bear for several weeks following the surgery.. Physiotherapy will help strengthen your child’s hip and leg muscles to improve recovery.

Although your child will not be able to participate in sports and other physical activities whilst the hip is healing, your child should be able to return to usual activities on your surgeon’s advice.