Slipped capital femoral epiphysis (SCFE)

Introduction

Slipped capital femoral epiphysis (SCFE) is a condition that affects the top of the femur (thighbone) of older children and teenagers.

It is a fracture of the growth plate at the top of the femur.  The ball at the top of the femur (the femoral head) sits on a growth plate, which is made of cartilage that is weaker than bone.  If the growth plate breaks, the femoral head will move or slip out of place. 

The change to the shape at the top of the femur will cause your child’s leg to turn outwards and affect the hip movement.

The exact cause is not known.  Some factors are thought to increase the chances of developing SCFE:

• being over a healthy weight range
• about to, or going through puberty
• about to, or going through a growth spurt
• hormone (endocrine) problems
• boys are affected more than girls

• pain in the thigh or knee, rather than the hip (this is known as referred pain)
• a limp or unable to walk on the leg
• leg and foot are turned out
• child is unable to squat down or get up without help

There are three types of SCFE:

1. chronic – the SCFE develops gradually over weeks or months.  The pain comes and goes.   
2. acute – the SCFE develops quickly.  Your child may have fallen or hurt themselves playing sport.
3. acute on chronic – your child may have had a sore leg for weeks or months, but the pain has suddenly become worse. 

These can be further divided into stable and unstable injuries:

Stable – your child has a limp, but can still walk. These slips are usually not as severe.

Unstable – your child cannot walk on their leg. These are usually more severe injuries.

Your child’s doctor will be able to make a diagnosis, based on their signs and symptoms and/or after any appropriate tests.

If SCFE is not treated, it will become worse, and may lead to arthritis in the hip. Treatment helps to reduce the risk of later arthritis

Your child will require surgery to stabilize the hip. One or two screws will be screwed into the ball of the femur to prevent further movement. This can be done through a very small cut.

Your child will have a short stay in hospital and their hip will feel better straight after surgery. Your child will need to move around on crutches for the next six weeks while the hip heals.

After surgery, the screws are not removed unless a complication develops. They should not be removed before your child stops growing.

Monitoring your child

SCFE can occur later on the other hip. If the other hip is hurting, see your child’s doctor straight away. The other hip will be monitored and operated on if there is a suspicion of SCFE.

Some children will have unstable SCFE. This condition carries the added risk of an injury to the femoral head blood supply and will require more complex treatment, as will severe cases of chronic SCFE.

Your doctor will discuss this with you, if it applies to your child.