Slipped Capital Femoral Epiphysis (SCFE)

What is Slipped Capital Femoral Epiphysis (SCFE)?

Slipped Capital Femoral Epiphysis (SCFE) is the most common Hip problem in adolescents; twice as likely to affect boys (12-15 years) than girls. There is a displacement of the femoral shaft, though the growth plate, on the femoral capital epiphysis (head).

Figure 1. AP and Frog-Lateral X-rays showing SCFE.

Causes and Symptoms of Slipped Capital Femoral Epiphysis

Its cause is deemed to be multifactorial, with obesity being the greatest risk factor. Other contributory factors could be structural variances in the hip predisposing to the slip; changes in hormones leading to changes in the integrity of the growth plate.

It typically occurs in overweight children and they may report a recent onset of pain involving the hip, groin or knee; or a painful limp. This complaint may be sudden (acute) or a more indolent course over a period of time (chronic), or even a sudden worsening in a sustained baseline of pain (acute-on-chronic).

It can occur in both hips, and this is usually associated with other medical (endocrine) disorders.

The child may or may not be able to bear weight on the affected limb and this is significant as the child who is unable to do so is deemed to have an unstable slip. This would require a more urgent stabilisation in order to prevent osteonecrosis (bone death) of the femoral head.

Figure 2.

Excessive external rotation of hip on one side is indicative of pain in the hip. Subsequent flexion of said hip will demonstrate an obligatory external rotation sign.

How is Slipped Capital Femoral Epiphysis Diagnosed and Treated?

Treatment thus centers on preventing the progression of the deformity while avoiding complications.

X-rays are usually sufficient for the making of the diagnosis, although MRIs may be required in those presenting with very early stages of the disease.

Treatment involves surgical stabilization with screws. The timing of the surgery depends on the stability of the slip. Unstable ones should be operated on with more urgency for the reason stated above.

Figure 3.

Figure 4.

If surgery is performed at an early stage, it arrests the disease and obviates the complications that may arise with delayed fixation. The latter may require surgical interventions of a more severe nature.