Slipped Capital Femoral Epiphysis (SCFE)

Hip Dislocation


Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip and can occur during adolescence. It happens when the head of the femur, which is also known as the “ball” part of the bone, slips backwards and downwards at the growth plate. The growth plate is located in the “neck” area of the femur between the ball section and the long shaft section of the bone, and is made up of soft and flexible cartilage. Because the growth plate is weaker than the rest of the bone during the adolescent years of rapid bone growth, SCFE can cause changes in the normal alignment of these sections of the bone. It can happen gradually or suddenly due to an injury, and can occur in one or both hips. Symptoms include pain in the hip, groin, thigh, or knee.

Types of Slipped Capital Femoral Epiphysis

SCFE can be classified into two types: stable and unstable. In the case of stable SCFE, your child will still be able to walk, but may experience an intermittent limp that worsens with activity and improves with rest. The condition may result in pain, stiffness, or discomfort in the hip, groin, or knee. On the other hand, unstable SCFE is more severe, causing your child to be unable to bear weight on the affected leg. This type of SCFE tends to occur suddenly and is accompanied by more intense pain. It can also lead to more severe complications.

Symptoms of Slipped Capital Femoral Epiphysis

The signs and symptoms of slipped capital femoral epiphysis are as follows:

  • Pain in the hip, groin, or knee of the teenager.
  • Stiffness in the hip of the teenager.
  • The foot or leg of the teenager may turn outward.
  • Walking with a limp.
  • In severe cases with extreme pain, the teenager may not be able to put weight on the leg.
  • One leg may appear shorter than the other.

The symptoms may persist for several weeks to four or five months before a diagnosis is made.

Causes of Slipped Capital Femoral Epiphysis

SCFE is a common hip disorder in adolescents that usually occurs in overweight children between 11 and 16 years old, more frequently in boys than girls. It affects approximately 11 out of 100,000 pre-teens and teens. The exact cause of SCFE is not well understood. Nevertheless, some factors or associations that increase the risk of developing this condition have been identified by researchers, including being overweight, a fall or injury to the hip-thigh area, endocrine disorders such as osteodystrophy, hypothyroidism, hyperthyroidism, hypopituitarism, and growth hormone deficiency, renal (kidney) disorders due to their impact on calcium, a crucial building block of bone, and having a family history of SCFE.

Diagnostics of Slipped Capital Femoral Epiphysis

SCFE is diagnosed through physical exam including rotation of the affected leg, observation while walking and X-rays. A MRI may be ordered if the diagnosis is not able to be made with X-rays and your healthcare provider still suspects your child has SCFE. Your provider may also order blood work to check for other medical conditions.

Complications of Slipped Capital Femoral Epiphysis

The major complications associated with SCFE include avascular necrosis and chondrolysis. Avascular necrosis occurs when the femoral head slips severely, leading to the cut-off of blood supply and collapse of the hip. This can cause rapid and severe osteoarthritis, which may require reconstructive hip surgery. Chondrolysis, on the other hand, is characterized by the sudden and severe destruction of cartilage in the hip joint.

Other potential complications of SCFE include premature growth plate closure of the femur, the development of SCFE in the other hip, and early onset of hip osteoarthritis.

Treatment of Slipped Capital Femoral Epiphysis

Surgical treatment is necessary to address slipped capital femoral epiphysis (SCFE). The goal of surgery is to prevent further slippage and complications. The most common type of surgery for this condition is called screw fixation. During this procedure, the surgeon inserts a screw from the side of the top of the femur, through the neck of the femur, growth plate, and into the “ball” section of the femur. The screw helps to prevent the “ball” section from slipping out of place. Surgery is usually done as soon as possible to avoid worsening of the condition. In the meantime, the affected leg should be rested and kept weight-free as much as possible using crutches, a walker, or wheelchair. Pain medication will also be prescribed. The recovery time after surgery will vary for each patient and depends on factors such as the severity of the SCFE and the type of surgical procedure done. Generally, stable SCFE patients will need crutches or a walker for up to four weeks after surgery, while unstable SCFE patients will need them for at least six to eight weeks. A physical therapist will help the patient to strengthen leg and hip muscles and improve range of motion. The prognosis of the patient depends on the severity of the slip and the cause. Patients with SCFE are at an increased risk of developing osteoarthritis, and reconstructive hip surgery may be required if symptoms persist and worsen over time. The physician will advise the patient on when they can resume normal activities, including sports.