Slipped Capital Femoral Epiphysis | Symptoms and Causes

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Right now, you probably have lots of questions: How serious is slipped capital femoral epiphysis? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Boston Children's Hospital can explain your child’s condition fully when you meet with us.

The normal hip joint

The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear.

The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

What is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects teens and, less commonly, kids. In SCFE, the head, or "ball," of the thighbone (referred to as the femoral head) slips off the neck of the thigh bone, much like how a scoop of ice cream can slip off the top of a cone. This condition causes the hip joint to become painful and stiff.

Slipped capital femoral epiphysis (SCFE) is usually an emergency and must be diagnosed and treated early. In 20 to 40 percent of affected children, SCFE will be present in both hips at the time the child is diagnosed. If only one hip is affected, the other hip will eventually slip 30 to 60 percent of the time. Treatment is surgical.

What causes slipped capital femoral epiphysis?

In pre-adolescent and adolescent growth and development, a child is growing quickly, as adult hormones begin to circulate in his system. The cartilaginous growth plate (not as strong as bone) gets weaker because it’s broadening. These phenomena, combined with certain anatomical factors, such as the shapes of the femur and the socket, can lead to slippage.

SCFE is an unusual condition which is slightly more likely to occur in boys than girls.  SCFE occurs in about 1 per 1,000 to 1 per 10,000 children and teens–children ages 12 to 14 years are most at risk. SCFE is more prevalent in the northeast region of the United States than in the southwest, and is more prevalent among African-Americans.

Risk factors that increase the likelihood of SCFE include:

•   obesity
•   hormonal abnormalities (thyroid, etc.)
•   genetic predisposition (runs in families)
•   medications, such as steroids
•   radiation treatment
•   chemotherapy
•   bone problems related to kidney disease

What are the signs and symptoms of SCFE?

Some signs and symptoms can include:

•   pain in the hip that’s aggravated by activity and that may subside with rest
•   pain in the groin, thigh or knee in addition to—or instead of—hip pain
•   walking with a limp, trouble walking, or feeling like the leg is "giving way"
•   walking with a leg turned outward (unilateral slip)
•   walking with a waddle (bilateral slip)
•   inability to sit with knees straight ahead (knees tend to turn outward)

What should I ask my Boston Children’s doctor?

Some of the questions you may want to ask include:

•   Could you describe what’s wrong with my child’s hip joint?
•   Are other tests needed to confirm this diagnosis?
•   Is there, or could there be, damage to his tissues or blood vessels?
•   Does my child really need treatment for this? What treatment options are there?
•   Will SCFE permanently affect his growth plate and the normal growth of his leg?
•   How long will it take for him to heal?
•   Will he need to use crutches? If so, when, and for how long?
•   Will he need rehab or physical therapy?
•   Will there be restrictions on my child’s activities? If so, for how long?
•   Could there be long-term effects? Pain? Arthritis?
•   How long should my child be followed by his care team?
•   What can we do at home?

Complications

The majority of surgical treatments of SCFE at Boston Children’s occur without major complications. But if left untreated, the condition will eventually become painful, and osteoarthritis (OA) and its attendant problems may result.

Severe cases of SCFE require complex surgeries that involve some risk to the femur’s blood supply and bone health. In rare cases, damage to blood vessels can result in osteonecrosis, or bone death.

Later in life, hip problems can recur, even after successful treatment during childhood. For example, femoral acetabular impingement (FAI) is a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip). FAI is a research topic that Boston Children’s is working on extensively.

Slipped capital femoral epiphysis glossary

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•   acetabulum: hip socket; a part of the pelvis
•   arthritis (osteoarthritis): joint inflammation, resulting in pain, swelling, stiffness and limited movement.
    Arthritis can occur when a joint’s cushioning cartilage wears away.
•   avascular necrosis (osteonecrosis): a condition in which poor blood supply to a bone leads to bone death;
    the head of the femur is a common site of this condition
•   The Center for Families at Boston Children’s: dedicated to helping families find the information, services
    and resources they need to understand their child’s medical condition and take part in their care
•   cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move
    easily without pain
•   developmental dysplasia of the hip (DDH, hip dysplasia): a spectrum of hip abnormality—ranging from
    a minor laxity of the ligament that holds the ball in the socket to a complete dislocation, in which the ball is
    entirely out of the socket.
•   diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
•   epiphysis: a secondary bone-forming center at the head (ball) of the femur
•   femoral acetabular impingement (FAI): a “bump” on the neck of the femur that permanently remains as
    a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative
    damage to the cartilage inside the hip).   
•   femoral head: round-headed top of the thigh bone (femur)
•   femur: the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral
    head) joins the hip socket (acetabulum) to form the hip joint.
•   MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets,
    radio frequencies, and a computer to produce detailed images of organs and structures within the body
•   onset (of signs or symptoms): the first appearance of signs or symptoms
•   open reduction surgery: a procedure in which the doctor repositions the hip bone into the socket through
    an incision into the patient’s body
•   orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the
    skeletal system, spine and associated muscles, joints and ligaments
•   orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders
    and injuries to the spine, skeletal system and associated muscles, joints and ligaments
•   osteonecrosis (avascular necrosis): the death of a bone due to loss of blood supply
•   osteotomy: a surgical procedure that involves cutting a bone
•   physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients
    improve or regain muscle strength, mobility and other physical capabilities
•   physis: growth plate at the ends of bones
•   slipped capital femoral epiphysis (SCFE): a hip joint condition in which a weakness of the growth plate (physis)
    in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to
    slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a
    fracture of the growth plate.
•   X Ray: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues,
    bones, and organs onto film; to diagnose SCFE, front and side views are usually needed, as well as views of the
    opposite knee

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