Slipped Capital Femoral Epiphysis (SCFE)


Slipped Capital Femoral Epiphysis (SCFE) is a common hip disorder in adolescents causing slippage or separation of the femoral head (ball at the upper end of the femur) from the weakened epiphyseal growth plate (growing end of the bone).  This condition often develops during the rapid growth period after the onset of puberty, and may affect one or both legs at the same time.  The separation may be caused by an injury or other factors such as obesity and hormonal imbalances.  SCFE commonly occurs in children between ages 11 and 15 years and is more common in boys than girls.

Causes

The exact cause of SCFE remains unclear; however, the presence of certain factors may increase the risk of your child developing this condition.  These include:

  • Obesity – SCFE is more common in children who are obese and have rapid growth.  This may be due to increased pressure on the growth plates
  • Endocrine disorders – diabetes, thyroid disease, and growth hormone abnormalities
  • Kidney diseases
  • Radiation therapy or chemotherapy for childhood cancers
  • Steroid medications
  • Family history of the disorder

Types of SCFE

SCFE is classified into two types; stable and unstable SCFE, based on the severity of pain and damage

  • Stable SCFE – mild slip, this condition is considered mild or stable if the child is having mild pain or stiffness in the knee or groin but can manage to walk and may limp.  Symptoms worsen with activity and subside with rest.  In stable SCFE, the child is able to walk with or without the help of crutches
  • Unstable SCFE – severe slip, condition is considered severe if the child is having severe pain and stiffness that may limit movement.  The child may not be able to walk or even put weight on the affected side

Signs and Symptoms

Children with SCFE exhibit certain characteristic signs and symptoms depending on the severity of the slip.  The signs and symptoms of stable SCFE include:

  • Stiffness in the hip
  • Pain in the groin, the thigh or the knee that lasts from several weeks to months
  • Limping while walking
  • Restricted movements of the hip
  • Outward twisting of the leg

The signs and symptoms of unstable SCFE include:

  • Severe pain, similar to the pain felt during fracture of a bone
  • Inability to move the affected leg
  • Inability to walk or bear weight on the affected leg

Diagnosis

Diagnosis is based on a detailed medical history and physical examination including observation of gait and hip range of motion.  X-rays of the hip help show the “slip” of the femoral head at the growth plate (epiphysis).  Other imaging tests may be ordered include:

  • Bone Scan – bone scans help in the early detection of avascular necrosis and chondrolysis, common complications of SCFE
  • Computer Tomography (CT) Scan – can help reveal the amount of slippage
  • Ultrasonography – can help evaluate between stable and unstable slips
  • Magnetic Resonance Imaging (MRI) Scan – may help determine possible complications including avascular necrosis

Treatment

The goal of treatment is to prevent progression or worsening of the slippage and is accomplished through surgery.  Surgical intervention involves either internal fixation with a metal screw or pin to hold the femur and femoral head in place.