Slipped capital femoral epiphysis (SCFE) factsheet
Introduction
The hip joint is made up of:
- the femoral head – the round top of the thigh bone
- the acetabulum – the cup-shared socket in the pelvis where the femoral head sits.
Inside the acetabulum, the femoral head sits on a growth plate made of soft tissue called cartilage. As your child grows, the growth plate lets the bones lengthen and become stronger.
Over time, the cartilage will turn into solid bone. This is usually around the end of puberty when your child has settled into their young adult body.
Slipped capital femoral epiphysis (SCFE) is when the growth plate fractures or breaks, causing the femoral head to move or slip out of place.
This change can cause your child’s leg to turn outwards and affect how they move their hip.
The exact cause of SCFE is not fully understood, but some factors that can increase the chances of developing SCFE include:
- being above a healthy weight range
- going through puberty or a growth spurt
- hormone problems
- being male, as boys are affected more than girls.
Signs and symptoms
Signs and symptoms of SCFE can include:
- pain in the thigh or knee, known as referred pain
- limping or not being able to walk on the leg
- the leg and foot turning outwards
- difficulty squatting down or standing up without help.
Types of SCFE
There are three types of SCFE:
- chronic – develops gradually over weeks or months with pain that comes and goes
- acute – develops quickly, often after a fall or sports injury
- acute on chronic – a sore leg for weeks or months that suddenly gets worse.
SCFE can also be split into stable and unstable injuries:
- stable – your child can still walk, usually with a limp. These are less severe at first
- unstable – your child cannot walk on the leg. These are more severe injuries.
Diagnosis
Your child’s doctor can diagnose SCFE based on the child’s signs and symptoms and any other appropriate tests.
Treatment
If left untreated, SCFE can get worse and lead to arthritis in the hip. Arthritis is a condition that causes pain, swelling, and stiffness in a joint due to damage or wear over time.
Treatment requires surgery to help stabilise the hip and reduce the risk of arthritis later in life. The surgeon will insert one or two screws into the top of the femur to keep it in place.
After the surgery, your child will stay in the hospital for a short time, and their hip should feel better immediately. They will need to use crutches for about six weeks while the hip heals.
The screws will stay in place unless there is a complication, and they should not be removed until your child stops growing.
Management
Long-term care
SCFE can sometimes happen in the other hip later on. If your child’s other hip starts hurting, see the doctor immediately. If SCFE is suspected in the other hip, it will be monitored and treated like the first hip.
Some children have unstable SCFE, which can affect the blood supply to the femoral head and may require more complex treatment.
Severe cases of chronic SCFE can also be more complicated. Your child’s doctor will discuss the treatment plan with you.
