Definition

What is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction. This causes pain, stiffness, and instability in the affected hip. The condition usually develops gradually over time and is more common in boys than girls.

Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. To achieve the best outcome, it is important to be diagnosed as quickly as possible. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including painful arthritis in the hip joint.

How common is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. It usually occurs in children eight to 15 years of age, and it is one of the most commonly missed diagnoses in children. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of slipped capital femoral epiphysis?

The common symptoms of slipped capital femoral epiphysis are:

  • Pain in the groin, knee or thigh
  • Limping
  • Stiffness in the hip
  • Rotated foot
  • One leg may appear shorter than the other

More severe cases of hip conditions are accompanied by extreme pain and the inability to move the affected leg.

There are two types of slipped capital femoral epiphysis: acute and chronic

 

Acute:

  • Presents within three weeks of onset of symptoms
  • Severe pain such that the child is unable to walk or stand.
  • Alterations in gait, including a limp on the affected side, external rotation of the leg and trunk shift.
  • Hip motion is limited, especially internal rotation and abduction, due to pain.
  • Obligate external hip rotation, Drehmann’s sign: demonstrated when the child is supine and the hip is passively flexed and then falls back into external rotation and abduction.
  • Acute-on-chronic: pain, limp and altered gait occurring for several months, suddenly becoming very painful.

Chronic:

  • Present more than three weeks after onset of symptoms.
  • Mild symptoms with the child able to walk with altered gait. In a significant number of cases knee pain is reported as the only symptom.
  • External rotation of the leg during walking. Range of motion of the hip shows reduced internal rotation with additional external rotation.
  • When flexed up, the hip tends to move in an externally rotated position – see Drehmann’s sign, above.
  • Mild-to-moderate shortening of the affected leg.
  • Atrophy of the thigh muscle may be noted.

 

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes slipped capital femoral epiphysis?

A slipped capital femoral epiphysis may affect both hips.

An epiphysis is an area at the end of a long bone. It is separated from the main part of the bone by the growth plate. In this condition, the problem occurs in the upper area while the bone is still growing.

Slipped capital femoral epiphysis occurs in about 2 out of every 100,000 children. It is more common in:

  • Growing children ages 11 to 15, especially boys
  • Children who are obese
  • Children who are growing rapidly
  • Children with hormone imbalances caused by other conditions are at higher risk for this disorder.

Risk factors

What increases my risk for slipped capital femoral epiphysis?

There are many risk factors for slipped capital femoral epiphysis, such as:

  • Mechanical: local trauma, obesity.
  • Inflammatory conditions: neglected septic arthritis.
  • Endocrine:Hypothyroidism, hypopituitarism, growth hormone deficiency, pseudohypoparathyroidism, vitamin D deficiency. 91% will be below the tenth percentile for height.

Previous radiation of the pelvis, chemotherapy, renal osteodystrophy-induced bone dysplasia.

Contralateral SCFE:

  • There is a high incidence of slip in the contralateral hip (27% in one series).
  • Controversy exists over whether or not a normal, asymptomatic hip should be fixed.
  • Scoring systems have been developed to stratify the risk; generally the younger the child is at presentation, the greater the risk of contralateral SCFE. Radiographic measurements of the angle of the growth plate to the neck of the femur are also used.
  • Weight loss to lower than 95% centile, following initial surgery, is associated with a lower risk of subsequent contralateral SCFE

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is slipped capital femoral epiphysis diagnosed?

Physical examination

During the examination, your doctor will ask about your child’s general health and medical history. He or she will then talk with you about your child’s symptoms and ask when the symptoms began.

While your child is lying down, the doctor will perform a careful examination of the affected hip and leg, looking for:

  • Pain with extremes of motion
  • Limited range of motion in the hip–especially limited internal rotation
  • Involuntary muscle guarding and muscle spasms

Your doctor will also observe your child’s gait (the way he or she walks). A child with SCFE may limp or have an abnormal gait.

X-rays

This type of study provides images of dense structures, such as bone. Your doctor will order x-rays of the pelvis, hip, and thigh from several different angles to help confirm the diagnosis.

In a patient with SCFE, an x-ray will show that the head of the thighbone appears to be slipping off the neck of the bone.

How is slipped capital femoral epiphysis treated?

Surgery to stabilize the bone with pins or screws will prevent the ball of the hip joint from slipping or moving out of place. Some surgeons may suggest using pins on the other hip at the same time. This is because many children will develop this problem in that hip later.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage slipped capital femoral epiphysis?

The following lifestyles and home remedies might help you cope with slipped capital femoral epiphysis:

Weight Bearing

After surgery, your child will be on crutches for several weeks. The doctor will give you specific instructions about when full weight bearing can begin. To prevent further injury, it is important to closely follow your doctor’s instructions.

Physical Therapy

A physical therapist will provide specific exercises to help strengthen the hip and leg muscles and improve range of motion.

Sports and Other Activities

For a period of time after surgery, your child will be restricted from participating in vigorous sports and activities. This will help minimize the chance of complications and enable healing to take place. Your doctor will tell you when your child can safely resume his or her normal activities.

Follow-Up Care

Your child will return to the doctor for follow-up visits for 18 to 24 months after surgery. These visits may include x-rays every 3 to 4 months to ensure that the growth plate has closed and that no complications have developed.

 

Depending upon the patient’s age and other factors, a team approach that includes a general pediatrician, endocrinologist, and/or dietician may be necessary for comprehensive care in the long run.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: September 5, 2017 | Last Modified: September 5, 2017

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