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Slipped Capital Femoral Epiphysis

Overview

Slipped capital femoral epiphysis (SCFE) is a condition primarily affecting adolescents in whom the femoral head (ball part of the hip bone) moves in a backward direction relative to the neck of the femur (thigh bone) because of the damage in the growth plate.

SCFE can be stable (the child can walk with or without crutches) or unstable (the child cannot put the body weight on the affected side).

  • Obesity and male sex (commonly observed in obese male teens).
  • Hormonal issues (such as thyroid disorders) and kidney disease.
  • Use of steroids.

  • Stable SCFE:
    • Difficulty in walking (the patient walks with toes pointing outwards).
    • Associated intermittent pain in the hip/groin or even in the knee of the affected side, which especially increases after walking/exertion.
  • Unstable SCFE: This is a more severe form of disease in which there is:
    • Sudden onset of pain after an episode of a recent fall.
    • The child is not able to walk without support.
    • The leg is externally (outwards) rotated.
    • There is a limb length discrepancy (the affected leg is shorter than the unaffected leg).
    • Occasionally, there could be bilateral (both sides) involvement in different stages.

  • Clinical tests may reveal pain around the hip region and limitation of the internal (inner) rotation of the hip.
  • X-rays are usually taken from two different angles and are sufficient to diagnose SCFE.
  • Magnetic resonance imaging (MRI) is beneficial in early cases when the X-rays cannot diagnose the disease.

Non-surgical treatment

This is usually helpful during the initial phase of the disease. This comprises:

  • Strict non-weight bearing on the affected side and rest.
  • Obesity treatment for children, if needed.
  • In fewer cases, the application of a hip spica cast (plaster) to immobilise the hip joint.

Surgery

This is advised when the non-surgical treatment fails and is usually done under general or spinal anaesthesia based on the general condition of the patients and their preferences.

  • In-situ fixation: The physician inserts 1–2 screws to prevent further slippage. Sometimes, the surgery is advisable on the opposite side as a prophylactic measure.
  • Open reduction: This is usually required for patients with a severe form of the disease (unstable SCFE) when closed reduction and screw fixation are not possible.

After surgery

To regain paediatric bone health, the patient is allowed weight bearing on the affected side after a couple of weeks and return to sports is permitted after 4–6 months depending on the recovery.

  • Avascular necrosis of the femoral head: Decrease in blood supply due to slippage of the head (ball part).
  • Chondrolysis: This is a rare but serious complication where the head of the femur (ball part) is resorbed.
  • Impingement: The hip movements are affected due to abnormal positioning of the femoral head.
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