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Conditions

Slipped Capital Femoral Epiphysis (SCFE)

Description

Slipped Capital Femoral Epiphysis, or SCFE, is a condition in which a child’s hip (the top part of the femur, or ball of the ball and socket joint of the hip) slips through the growth plate.  Think of it as an ice cream scoop falling off of the ice cream cone.  This can happen slowly over time, or it can happen immediately from a fall, car accident, or trauma, similar to a break or fracture.  This usually happens during the adolescent years, most commonly between the ages of 11 to 13 years for females and 12 to 14 years for males. For this problem to occur, the child or adolescent must still be growing because the slip happens through an open growth plate.  This problem is more common among overweight or obese patients, but can happen in slim patients.  Children with thyroid or kidney problems are at greater risk for this problem, as are people on growth hormone.  If someone has a SCFE on one side, there is a 1 in 4 chance that the other hip could develop this problem as well. 
 

Types of SCFE

Doctors divide SCFE into two main types, stable and unstable.  Stable SCFE is when the child or adolescent can still walk on the leg.  They may have pain or a limp, but they can still put weight on the leg.   An unstable SCFE is when the patient cannot walk, and the pain is similar to having a broken leg. This is an emergency and the child needs to be brought to the hospital as soon as possible.
 

Symptoms

Most patients complain of pain in the groin or hip, but some patients complain of pain in their thigh or knee.  The patient may not be able to walk or may walk with a limp.  Sometimes the patient may walk with the affected leg turned outward.  Many kids have been told they have growing pains or a muscle pull because of the thigh and knee pain.
 

Examination  

Examination includes a check for pain and motion in the hip.  The way the hip slips, the leg tends to point out.  As the hip is flexed, this pointing out is called “obligate external rotation.”  In this picture below, the patient has a right SCFE. The patient’s left leg remains straight as the hip is flexed. On his right leg, the leg rotates out, or externally, as the hip is flexed.  In addition to “obligate external rotation,” the child will have a limitation of internal rotation asymmetric to the other side.

SCFE Exam
Figure - Right SCFE. The right leg is rotated out
SCFE Exam
Figure - Normal left hip

 

X-rays and Tests

The diagnosis is confirmed with X-rays.  The X-ray includes the entire pelvis, so that the hips can be compared.  The most important view is the “frog lateral.”

SCFE
Figure - Red arrow points to the SCFE on the right hip on the “AP” X-ray view
SCFE
Figure - Red arrow points to the SCFE on the right hip on the “frog lateral” X-ray view.

 

Treatment

This problem must be treated with surgery.  The hip is held in place with one or two screws to prevent further slippage.  The surgery helps with the pain, but the leg will still point outwards when the patient is walking. Sometimes further surgery is needed to improve the shape of the hip in the future. 
 

Outcomes (Prognosis/Expectations)

Outcomes vary after this problem.  If the slip is stable and treated quickly, most patients return to sports and activities.  If the slip is not stable, there is a risk of loss of blood supply to the ball of the ball and socket joint (femoral head).  Unfortunately, this problem sometimes leads to pain, limp, and the need for further surgery.

Healed SCFE
Figure - Screw in a left SCFE that healed. The growth plates have closed.

More Information

Q. Who gets a SCFE?

SCFE is more common in overweight patients usually between the ages of 8 and 14 years and patients with thyroid problems, kidney problems, or those taking growth hormone. 
 

Q. Which kind of doctor takes care of a SCFE?

Orthopedic surgeons take care of patients with SCFEs.  This condition is treated with surgery. 
 

Q. Does my child really need to have surgery for a SCFE?

Yes.  Surgery is necessary to stop the slipping through the growth plate of the hip. If your child does not have surgery, there is risk for continued slipping and damage to blood supply to the hip.   This damage will cause the hip joint to wear out, develop arthritis, and limit your child’s activity level. 
 

Q. Does my child need an X-ray?

Yes.  An X-ray is needed to make this diagnosis, and the X-ray should include the other hip as well.
 

Q. My child had a SCFE.  Do I need to worry about the other hip?

Yes.  A child who had a slip on one side has a 1 in 4 chance of slipping their other hip.
 

Q:  When can I stop worrying about the other hip?

Once a child is finished growing and the hip growth plate is closed, it can no longer slip. 
 

Q:  If my child has pain in the hip or knee and I am worried about a SCFE, can a trip to the specialist wait?

No.  A child with a SCFE should be seen quickly, so that if the hip is slipped, it can be protected from further damage. 
 

Q. My child had a SCFE.  Can he or she return to sports?

Most doctors will allow their patients to return to sports after a SCFE once the growth plate is healing, there is no pain, and they have returned to full strength.