Slipped Capital Femoral Epiphysis in Children

  • We treat children from birth through childhood, adolescence and young adulthood. Our decades of experience following our patients into adulthood have taught us that kids' hip problems affect them as adults. Our goal is to do everything possible so that the hip will do fine for a lifetime.

    ––Michael B. Millis, MD, professor of orthopedic surgery, Boston Children's Boston

    f your teen or child has been diagnosed with slipped capital femoral epiphysis (SCFE), you’ll have concerns and questions about his treatment, recovery, outlook and other issues. It will comfort you to know that Boston Children's Hospital is a world leader in orthopedic pediatrics. We specialize in innovative, family-centered care that supports the child and family every step of the way.

    About slipped capital femoral epiphysis

    • Slipped capital femoral epiphysis (SCFE) is one of the most common developmental conditions of the hip joint; it usually affects teens and pre-teens.
       
    • In SCFE, 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.
       
    • An SCFE is actually a fracture of the growth plate. The fracture is usually a fairly stable one, and the slippage occurs very slowly. Occasionally, the gradual slippage can become very unstable and the ball can completely slip, leading to severe deformity and even blood supply problems to the “ball.” For this reason, every hip with SCFE should be treated immediately to prevent the more immediate dangerous unstable SCFE.
       
    • SCFE can cause pain in the front or side of the hip, though just as often the pain may be felt in the thigh or knee. Often, a child with SCFE may have no pain, but only a limp and an out-toeing gate.
       
    • SCFE is often misdiagnosed as a “groin pull.” It is important to know that children and adolescents almost never get groin pulls, and every hip that seems to have a muscle problem in the groin should be considered as having an SCFE until x-rays prove otherwise.
       
    • A child who’s been diagnosed with SCFE must be seen and treated by an orthopedist as soon as possible. The treatment is a surgical one. He must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until he receives treatment.
       
    • In 20 to 40 percent of cases, SCFE affects both hips. If only one hip is involved at diagnosis, the other hip will slip in an additional 30 to 60 percent of cases.
       
    • Boys are affected more often than girls in a 1.5:1 ratio.
       
    • The mean age of the onset of symptoms for girls is 12 years, for boys, 13.5 years. The age range of onset is usually 12 to 14 years old, but can be earlier.
       
    • SCFE has three degrees of severity:
      • mild: about one-third of the femoral head slips off of the thigh bone
      • moderate: about one-third to one-half of the femoral head slips off of the thigh bone
      • severe: more than one-half of the femoral head slips off of the thigh bon
         
    • The more severe the case, the greater the likelihood that the teen or child will experience limited hip motion, differences in leg lengths, and further hip problems in adulthood.
       
    • With early detection and proper treatment, a positive outcome with few problems is possible.
       
    • At Children's, timely treatment for your child may include surgery and physical therapy to prevent the head of the thighbone from slipping further.
       

    How Boston Children's Hospital approaches slipped capital femoral epiphysis and other developmental hip conditions

    Whatever treatment your child with a hip problem requires, you can have peace of mind knowing that, as national and international orthopedics referral centers, Boston Children’s Child and Adult Hip Preservation Program, and Orthopedic Center have vast experience treating children who every kind of hip condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of SCFE.

    Unique expertise in treating adolescents with hip problems

    Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program, led by Michael Millis, MD, and Young-Jo Kim, MD, PhD, is the only such program of its kind. We offer the extensive experience and the most advanced techniques, with clinicians and researchers who are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Leaders in Bernese periacetabular osteotomy (Bernese PAO)

    At Boston Children's, we’ve performed more than 1,400 Bernese periacetabular osteotomies since 1991 to correct hip dysplasia in teens and adults. Our large volume makes us the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is Boston Children’s standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically from age 13 or 14 through adult).

    One of the first programs

    Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more 5,000 procedures each year. Our program, is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

    The World's Most Extensive Pediatric Hospital Research Enterprise

    Boston Children's is known for our innovative treatments and a research-driven approach. We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient.

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