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Slipped capital femoral epiphysis, or SCFE, (pronounced 'skiffy') is a hip condition seen in children who are still growing. With SCFE, the head of the femur, or epiphysis, slips down and backwards off the neck of the bone at the growth plate which has not fully developed yet. SCFE results in pain, stiffness, and hip instability. Without early detection and proper treatment, serious complications can result.
Causes of SCFE
SCFE is the most common hip disorder in adolescents which typically develops after the onset of puberty, during periods of rapid growth. While it can occur between the ages of eight and 15, it is often one of the most commonly missed diagnoses. SCFE often develops gradually over weeks or months, or may occur suddenly after a fall or other trauma to the hip. The cause of SCFE is not known, however there are several risk factors that may contribute to the condition.
SCFE Risk Factors
The risk factors that may make a child more likely to develop SCFE include:
- Endocrine or metabolic disorders
- Growth hormone problems and/or supplementation
- Kidney disease
- Obesity or excessive weight (most patients are above 95th percentile for weight)
- Growth spurts
- More common in boys than girls
- Family history of SCFE
Two Main Types of SCFE
SCFE is divided into two main types, stable and unstable. SCFE is usually found on only one side, however data indicates that in up to 40% of those with the diagnosis, SCFE will often occur on the opposite side over time.
- Stable SCFE: The child is able to walk or bear weight on the affected hip. They may need a crutch, cane, or walker, and may have pain or a limp, but are still able to put weight on that leg.
- Unstable SCFE: This is a more severe case where the child cannot walk or bear weight on that leg even with an assistive device. The pain in this situation is similar to having a broken leg and requires urgent treatment as soon as possible. Complications are more common with an unstable SCFE.
Common Signs and Symptoms of SCFE
The symptoms of SCFE vary with the severity of the condition, but common signs may indicate need for further evaluation when mild or stable SCFE is present. Some of the symptoms include complaints for weeks or months of intermittent pain in the groin, hip, knee, or thigh. The pain will typically become worse with activity with the child often exhibiting a limp when walking or running.
When unstable or more severe SCFE occurs, symptoms may include sudden onset of pain, and inability to walk or bear weight on the affected leg. Other symptoms that may be exhibited are leg length discrepancy or external or outward turning of the involved leg.
Surgical Treatment for SCFE
Treatment is accomplished through surgery, with the goal to prevent the head of the femur from slipping any further. Early diagnosis and treatment promotes the optimal outcome of hip stabilization, preserving long-term hip function, and preventing the development of further serious complications.
Orthopaedic Knowledge Online Journal 2008