Slipped capital femoral epiphysis (SCFE) is a condition where the head of the thigh bone slips off the neck of the bone at the growth plate.

The growth plate is the area of cartilage at the end of the bone responsible for bone growth. SCFE is more common in teenagers, particularly boys, and can affect one or both hips.

This article looks at the causes, symptoms, and treatment of SCFE.

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SCFE occurs when the growth plate weakens and cannot support the body’s weight, causing the femoral head to slip off the neck of the bone.

The slippage may occur slowly over time or suddenly, and it can occur in one or both hips.

SCFE is more common in boys than girls and is more likely to occur during the adolescent growth spurt.

Obesity is a risk factor for SCFE, as excess weight puts pressure on the growth plate in the hip. However, some cases of SCFE occur in individuals who are not overweight.

The exact cause of this is not fully understood, but experts believe it is related to a combination of factors, including:

  • Growth spurts: SCFE is most common during the adolescent growth spurt, when bones grow quickly and the cartilage in the growth plate acts as a weak point.
  • Hormonal changes: Changes in the body’s hormones during puberty can affect bone growth and increase the risk of SCFE.
  • Obesity: Excess weight puts extra pressure on the growth plate in the hip, increasing the risk of SCFE.
  • Genetics: SCFE can run in families, suggesting that there may be a genetic component to the condition.
  • Other medical conditions: Certain medical conditions, such as thyroid disorders, may increase the risk of SCFE.

It is important to note that not everyone with one or more risk factors will develop SCFE, and some people who develop SCFE may not have any of these risk factors.

Nonetheless, these factors may increase the risk of developing this condition.

The symptoms of SCFE can vary, but they generally include the following:

  • Pain: Pain in the hip, groin, thigh, or knee is the most common symptom of SCFE. The pain may initially be mild but may gradually worsen over time.
  • Limp: A person may develop a noticeable limp or have difficulty walking, especially as the condition progresses.
  • Limited range of motion: The affected hip may have a limited range of motion, making it difficult to perform certain movements or activities. It may also cause abnormal motion, with the leg being internally or externally rotated and shortened.
  • Weakness: Weakness in the affected leg may also occur, especially if the condition is left untreated for a prolonged period.
  • Stiffness: Stiffness in the affected hip joint may be present, making it increasingly difficult to move the hip.
  • Loss of height: In severe cases of SCFE, the affected leg may seem shorter than the unaffected leg due to the slippage of the femoral head.

People with SCFE commonly present with knee pain, because the hip pain is referred to the knee.

Because of this, doctors can miss SCFE. They may take X-rays of the knee, which turn up negative. This can cause the condition to worsen, possibly leading to poorer outcomes.

Diagnosing SCFE typically involves a combination of medical history, physical examination, and imaging tests.

Here are some common methods used to diagnose SCFE:

  • Medical history: The doctor will ask about any symptoms and any history of injury or medical conditions.
  • Physical examination: The doctor will examine the hip, looking for any signs of swelling, limited range of motion, or tenderness. They may also check for a limp or other gait abnormalities.
  • X-rays: X-rays can help confirm the diagnosis of SCFE by showing the position of the femoral head relative to the neck of the femur. X-rays can also reveal any additional abnormalities, such as avascular necrosis or arthritis.
  • Magnetic resonance imaging (MRI): MRI scans may provide more detailed images of the hip joint and surrounding tissues. MRI is particularly useful for detecting any damage to the blood vessels that supply the hip joint.

If a doctor diagnoses SCFE, they may order additional tests to determine the severity of the condition and plan the appropriate treatment.

SCFE treatment typically involves surgery to stabilize the affected hip and prevent further slippage. Here are some common methods used to treat SCFE:

  • In-situ pinning: This is the most common surgical procedure for treating SCFE. The surgeon inserts one or more pins through the femoral head and neck to hold them in place while the growth plate heals.
  • Open reduction and internal fixation (ORIF): In some cases, ORIF may be used instead of in-situ pinning. This involves making an incision to access the hip joint and realigning the femoral head with the neck before fixing it with screws or pins.
  • Osteotomy/osteochondroplasty: In severe cases of SCFE, the surgeon may need to perform an osteotomy or osteochondroplasty, which involves cutting and repositioning the bone to correct the slippage.

After surgery, the patient will need to undergo physical therapy to help restore strength and range of motion in the affected hip. They may also need to avoid putting weight on the affected leg for some time to allow for proper healing.

Sometimes, SCFE can lead to complications such as bone tissue death due to blood supply loss (avascular necrosis), arthritis, or degenerative joint disease.

In such cases, additional treatment may be needed to manage these conditions. Options may include:

  • core decompression, which involves drilling into any dead bone near the affected joint
  • femoral osteotomy, which involves cutting and aligning the femur
  • total hip replacement

The outlook for people with SCFE depends on several factors, including the severity of the condition, the age of the patient, and the type of treatment received.

Early diagnosis and treatment are key to improving the chances of a good outcome.

In-situ pinning has a high success rate for people with mild to moderate SCFE. Most patients can return to normal activities within a few months of surgery.

ORIF and osteotomy are more invasive procedures associated with a longer recovery period and may require a longer period of restricted activity.

Overall, the outlook for people with SCFE is generally good with proper diagnosis and treatment. However, early intervention is important to prevent complications and improve the chances of a full recovery.

SCFE is a condition that typically occurs in adolescence where the head of the femur slips off the neck of the bone at the growth plate.

It is more common in boys than girls and can occur in one or both hips. Obesity is a risk factor, but experts do not fully understand the exact cause of SCFE.