Slipped Capital Femoral Epiphysis
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SCFE is a slow separation and slippage of the growth plate of the femur at the hip joint. The head of the femur bone will usually slip backward and inward relative to the shaft. The deformity of the hip joint causes a loss of motion and abnormal stress in the joint which can lead to a limp. SCFE affects approximately 1-3 per 100,000 people, occurring in boys twice as often as girls. The slip usually occurs in early adolescence (12-15 years in boys, and 10-13 years in girls). The opposite hip will slip in roughly 25 percent of affected children within 18 months of the first one. The exact cause of SCFE is unknown but is typically found in children who are somewhat obese (greater than the 95th percentile for their weight). For children under the age of 10 years, endocrine problems (such as thyroid) are believed to contribute to weakening of the growth plate.
The symptoms of a slip can develop chronically, acutely, or acutely in a chronic situation. Your child may develop a painless limp over several weeks or months, or more commonly may complain of knee pain referred from the hip area. Due to the nerve supply to the hip joint, problems in the joint can present with pain in other parts of the leg such as the thigh or knee. If a child is able to walk the slip is considered stable; however, sometimes the slip develops suddenly and your child cannot walk or stand due to pain producing an unstable slip. Over time the hip slowly loses the ability to rotate inward and to flex, causing the child to walk in an abnormal manner, using the upper body to say to compensate for hip joint weakness.
The primary goal in treatment is to prevent further slippage of the hip, as greater degree of slip correlates with a higher likelihood of developing early arthritis. Therefore, as soon as the SCFE is recognized or suspected, your child should stop walking to avoid further trauma and slippage of the hip. In order to stop the slip, surgery is needed as soon as possible after diagnosis. Generally, surgery is done as soon as reasonably possible, within a few days. If the slip is unstable, your child may be admitted to the hospital. Typically, a single screw is placed across the growth plate through a small incision on the thigh. This screw will stimulate the growth plate to close faster than if it was left on its own, thus preventing further slippage. Your child will either go home that night, or stay in the hospital overnight for observation.
With a very severe slip, further corrective surgery may be needed at a later time, at least 1 year after pinning. The goal is to cut the bone and fix it with a plate and screws to correct the deformity caused by the slip. The reason that not all slips are corrected is that the risk of damage from correcting a minor slip is far greater than the risk of developing arthritis if the slip is stabilized "where it lies" with a screw. In the minor slip, the long term prognosis is often excellent if recognized early and treated promptly.
After surgery, your child will be allowed out of bed on crutches and usually not allowed to bear weight on that leg for about a month. Your child will be prohibited from any activity that puts stress on the hip until the growth plate has closed (approximately 3 to 6 months). Activities such as football, skateboarding, rollerblading, skating, skiing, basketball and other contact sports are not allowed the first 3 months after surgery. Aerobic exercise such as swimming and stationary biking are encouraged.
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