Definition A slipped capital femoral epiphysis, or SCFE, is a slipping and displacement of the growing end of the thighbone, or femur, in the hip socket. This condition usually occurs in growing adolescents.
What is going on in the body? The epiphysis is the end of the bone where growth occurs. During childhood, this area is growing until the bones reach maturity during the teenage years. It is therefore the weakest part of the bone and may slip off the neck of the thighbone if placed under great stress. The slip may occur suddenly or gradually.
What are the signs and symptoms of the condition? There is often a complaint of pain in the hip, thigh or knee. A limp of varying severity occurs. Motion of the hip may be stiff and limited. In addition, the leg may become shorter by 1 to 3 centimetres, which is roughly one inch.
What are the causes and risks of the condition? Several factors increase the risk of SCFE, including:
having SCFE on one side of the body, which increases the risk that it will develop on the other side of the body
What can be done to prevent the condition? Avoidance of obesity can help prevent some cases of SCFE. Sports safety guidelines should be followed for adults, adolescents, and children. In most cases, little can be done to prevent this problem.
How is the condition diagnosed? SCFE is suspected based on the person's age and the reported signs and symptoms. The diagnosis is confirmed by a joint x-ray of the hips. Early diagnosis and treatment usually results in a better outcome.
What are the long-term effects of the condition? If left untreated, a mild slip may progress to a more severe one. A significant slip can lead to joint deformity and arthritis in adult years.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? Immediate treatment is used for most slips that cause sudden symptoms. Initial treatment usually consists of the use of crutches with no weight bearing on that leg. Surgery is then usually performed to correct the slippage. An orthopaedic surgeon, or bone specialist, generally performs the surgery.
Surgery may be fairly minor and involve only placing a metal pin through the skin and into the hip's growth plate. If the slipping is more severe, the hip area may need to be cut open. In this procedure, the epiphysis can be put back in its proper place on the end of the bone.
In some cases, the condition happened a while ago and has healed in the slipped position. In this setting, treatment often consists of observation alone. For a severe slip, an operation may be needed to realign the hip.
After surgery, a person should avoid vigorous sports or other activities until healing has taken place, which usually takes a few weeks. The individual may need to use crutches for several weeks. In severe cases, a cast may be needed for several weeks and the person is unable to walk until the cast is removed.
What are the side effects of the treatments? If not treated promptly, the slip may progress. Death of the bone cells in the epiphysis is a rare problem. An operation may cause an infection. Rarely, in pinning of the slip, the cartilage at the end of the bone in the hip joint may dissolve, causing arthritis in an adolescent. There is also potential for arthritis as an adult.
What happens after treatment for the condition? After the growth area has fused, or become solid, the hip is strong and the person may be fully active, unless arthritis symptoms are limiting. The person must remain on crutches or in a cast until the epiphysis heals, which may take several weeks.
How is the condition monitored? After complete and proper treatment, no further monitoring may be needed on the affected side. However, it is important to pay particular attention to symptoms or signs in the opposite hip. Joint x-rays can be taken to ensure that a similar problem does not exist. Any new or worsening symptoms should be reported to the doctor.
Author: John A.K. Davies, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
