Slipped Capital Femoral Epiphysis
Definition of Slipped Capital Femoral Epiphysis
Slipped Capital Femoral Epiphysis (SCFE) is defined as the femoral neck and femoral shaft (top portions of the femur) moving either posteriorly (back), anteriorly (forward) or laterally (to the side) away from the femoral epiphysis and acetabulum (the ball portion of the femur). A SCFE can be either unilateral (one side) or bilateral (both sides).
Types of Slipped Capital Femoral Epiphysis
There are three types of SCFEs: Acute, Acute-on-chronic, and Chronic
- Acute: Sudden onset of symptoms for 3 weeks or less after an injury, such as twisting or falling occurs.
- Acute-on-chronic: Sudden onset of severe pain in hips or knees (usually after an injury such as twisting or falling) after having vague hip or knee pain for greater than 3 weeks.
- Chronic: Vague symptoms of groin, thigh or knee pain and limping lasting for greater than three weeks. This is the most common type of SCFE.
SCFEs can be further defined as stable or unstable.
- Stable: Child is able to walk with or without crutches.
- Unstable: Child is not able to walk with or without crutches. The diagnosis of an unstable SCFE has a much higher incidence of complications and requires timely surgical treatment.
Clinical Presentation/Symptoms of Slipped Capital Femoral Epiphysis
The following are signs and symptoms that may be present with a SCFE:
- Groin, hip, knee, and/or thigh pain
- Difficulty with movement of hip or lifting affected leg to climb stairs
- Walks or runs with a limp
- Outward turn (external rotation) of affected leg.
These symptoms may vary or not all be present, depending on the severity and type of SCFE.
Causes of Slipped Capital Femoral Epiphysis
The cause of a SCFE is unknown but several factors may contribute to the development of a SCFE
- Mechanical Factors
- Endocrine Factors
Mechanical: A SCFE usually occurs during the adolescent years when a growth spurt is or has occurred. When a growth spurt occurs, it stimulates the epiphysis to make bone grow and that can cause weakness in the bone, leading to a slip of the femoral head.
Endocrine: Children with hypothyroidism, hyperthyroidism or hypogonadal conditions have been shown to have an increase chance of developing a SCFE.
In addition, factors such as obesity, race (African Americans more common) and gender (boys affected more often than girls) can also be a contributing factor.
Diagnosis/Tests for Slipped Capital Femoral Epiphysis
X-ray: Pictures of the hip, thigh and pelvis are taken of both legs to compare. From these x-rays, the severity of the slip and the treatment options can be determined.
Treatment of Slipped Capital Femoral Epiphysis
Almost all patients need surgery to treat a SCFE. Depending on the severity of the SCFE determines the type of surgical procedure that will be performed. The two most common types of surgery are in-situ pinning and surgical hip dislocation with subcapital osteotomy.
- In-Situ pinning: Placing a screw into the top of the femur to hold the bone in place and stop the slip. Usually this procedure is done on stable SCFEs.
- Surgical hip dislocation with subcapital osteomy.
Complications of Slipped Capital Femoral Epiphysis
Timely diagnosis and treatment are important to help decrease the chance of complications. However, despite treatment, a patient with SCFE may develop complications. Chondrolysis or damage to the cartilage (a soft connective tissue in the joint) is damage that may lead to joint stiffness and pain.
Avascular necrosis (AVN) is when blood flow to the bone is reduced or absent. AVN causes the bone to die from the inside out, leading to bone deformity, pain, and arthritis.
Both of these problems are more common in unstable SCFE. Further surgical intervention may be needed if either of these complications occur.