Dr

Slipped capital femoral epiphysis (or SCFE, for short) is a hip problem that starts if part of the growing end (the epiphysis) of the thigh bone (the femur) slips off from the top of the thigh bone. SCFE may develop in one leg or it may occur in both legs.

SCFE usually occurs in children between 11 and 16 years of age. SCFE often occurs in children who are overweight. More boys than girls get SCFE, and it's more common in blacks than in whites. The cause of SCFE usually isn't known. SCFE is typically divided into 2 types: stable and unstable.

A child is considered to have "stable" SCFE if he or she can walk with or without crutches. More than 90% of cases are stable.

A child who can't walk, even with crutches, has "unstable" SCFE. Unstable SCFE often occurs after a trauma, such as a sports injury or a fall. Falling can also turn a stable SCFE into an unstable one.

A child with stable SCFE may first have stiffness in the hip, which may get better after rest. After a while, the stiffness may turn into a limp, and the child may have pain that comes and goes. The pain is often felt in the groin, the thigh or the knee, and not necessarily in the hip itself.

In the later stages, the child may lose some ability to move the involved hip. This leg will usually twist out. It may look shorter than the other leg. He or she may not be able to play sports or do simple tasks like bending over to tie his or her shoes. The symptoms may change gradually or rapidly.

A child with unstable SCFE has extreme pain. The pain is similar to what might be felt with a broken bone. The child probably won't be able to move the injured leg. If you think your child has unstable SCFE, don't force the leg to move. That could make the thigh bone slip even more.

To check for stable or unstable SCFE, your doctor will take x-rays that show the pelvis and thigh area from several different angles. Your doctor will then decide which tests are needed and explain each test to you.

Once SCFE is diagnosed, your doctor will probably refer your child to an orthopedic surgeon (a doctor who fixes bone problems). Surgery is usually the treatment of choice. It's important to get treatment right away.

The most common treatment of SCFE is called "in-situ fixation." With this treatment, the bone is held in place with a single central screw. This screw keeps the thigh bone from slipping and will close the growth plate. The results of this treatment are very good. It has few complications.

Other surgical treatments (including in-situ fixation with more than one screw) are used less often. Ask your doctor to explain the potential benefits and risks of the treatment options.

The most serious complications of SCFE are avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of cartilage). Avascular necrosis is more common in patients with an unstable SCFE.

The risk of these complications increases as the severity of SCFE increases. This is why it is important to get treatment right away.

Getting better takes time. For 4 to 6 weeks after surgery, your child will need to use crutches to walk. Then your child can slowly get back into normal activities, including running and contact sports.

If SCFE is caught early, there is a very good chance for full recovery, especially if SCFE is stable. However, some children who have had SCFE may get arthritis in the hip later in life.