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Slipped Capital Femoral Epiphysis
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Am Fam Physician. 1998 May 1;57(9):2148-2150.
See related article on slipped capital femoral epiphysis.
What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (or SCFE, for short) is a hip problem that starts if part of the growing end (the epiphysis) of the thigh bone (the femur) slips off from the top of the thigh bone. [ corrected] SCFE may occur in one or both legs. SCFE may develop in one leg first or it may occur in both legs at the same time.
Who can get SCFE?
SCFE usually occurs between 11 and 16 years of age. It's the most common hip problem among teenagers. SCFE often occurs in children who are overweight. More boys than girls get SCFE, and it's more common in blacks than in whites. The cause of SCFE usually isn't known. SCFE is typically divided into two types: stable and unstable.
What's the difference between stable and unstable SCFE?
A child is considered to have “stable” SCFE if he or she can walk with or without crutches. More than 90 percent of cases are stable. A child who can't walk, even with crutches, has “unstable” SCFE. Unstable SCFE often occurs after a trauma, such as a sports injury or a fall. Falling can also turn a stable SCFE into an unstable one.
What are the symptoms of stable SCFE?
A child with stable SCFE may first have stiffness in the hip, which may get better after rest. After a while, the stiffness may turn into a limp, and the child may have pain that comes and goes. The pain is often felt in the groin, the thigh or the knee, and not necessarily in the hip itself.
In the later stages, your child may lose some ability to move the involved hip. This leg will usually twist out. It may look shorter than the other leg. Your child may not be able to play sports or do simple tasks like bending over to tie his or her shoes. Your child's symptoms may change gradually or rapidly.
What are the symptoms of unstable SCFE?
If your child has unstable SCFE, he or she will have extreme pain. The pain is similar to what might be felt with a broken bone. Your child probably won't be able to move the injured leg. If you think your child has unstable SCFE, don't force the leg to move. That could make the thigh bone slip even more.
How is SCFE diagnosed?
To check for stable or unstable SCFE, your doctor will take x-rays that show the pelvis and thigh area from several different angles. Your doctor will then decide which tests are needed and explain each test to you.
How is SCFE treated?
Once SCFE is diagnosed, your doctor will refer your child to an orthopedic surgeon (a doctor who specializes in fixing bone problems). Surgery is usually the treatment of choice. It's important to get treatment right away.
The most common treatment of SCFE is called “in-situ fixation.” In this treatment, the bone is held in place with a single central screw. This screw keeps the thigh bone from slipping and will close the growth plate. The results of this treatment are very good. It has few complications.
Other surgical treatments (including in-situ fixation with more than one screw), are used less often. Ask your doctor to explain the potential benefits and risks of your treatment choices.
What are the complications of SCFE?
The most serious complications of SCFE are avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of cartilage). Avascular necrosis is more common in patients with an unstable SCFE.
The risk of these complications increases as the severity of SCFE increases. This is why fast treatment is so important.
When can my child get back to normal activities?
Getting better takes time. For four to six weeks after surgery, your child will need to use crutches to walk. Then your child can slowly get back into normal activities, including running and contact sports.
Will my child recover completely?
If SCFE is caught early, there is a very good chance for full recovery, especially if it is stable. Fast treatment is very important. However, some children who have had SCFE may get arthritis in the hip later in life.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1998 by the American Academy of Family Physicians.
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