Slipped Capital Femoral Epiphysis

Causes

SCFE usually occurs in children between 11 and 16 years old. 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.

Symptoms

• Pain (hip, knee, thigh, or groin pain) often exacerbated by movement of the hip or ambulation. Hip pain may be referred to the medial knee. Therefore any limping child with knee pain needs an assessment of the hip as well.
• Altered gait
• Pain and limp can be acute or chronic. Small amounts of slippage can occur over a period of months, and an acute slip may be superimposed on chronic slippage after relatively minor trauma (the so-called "acute-on-chronic" slip).

Signs

• The hip is held in relative flexion and external rotation.
• Passive hip flexion may accentuate the external rotation deformity.
• Internal rotation and abduction may be limited.
• Atrophy of the thigh if symptoms have been long-standing.
• Shortening of the affected lower extremity depends on the degree of slippage.

Treatment

Surgery to stabilize the bone with pins or screws will prevent further slippage or displacement of the ball of the hip joint. Some surgeons may offer to pin the unaffected hip at the same time, because many children will develop a slip of this hip as well.

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 good. It has few complications.

Prevention

Weight control for obese children may be helpful. Many cases are not preventable.