What is a Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) is a disorder in which the head of the femur slips off the neck of the femur posteriorly and medially. This occurs at the growth plate and is most often seen during periods of rapid growth or shortly after the onset of puberty (11-13 years). The typical patient is overweight.

What is the incidence?
SCFE occurs in 2/100K live births. It is seen two or three times as often in males as females. The incidence of bilateral slips is 25-30%.

What are the symptoms?
SCFE may be acute, chronic or acute on chronic. Chronic slip is the most common. In a chronic SCFE, the child has a history of weeks to months of hip or knee pain on the affected side. There is an associated limp and the foot is turned out.

Acute SCFE is associated with a sudden onset of pain and may be related to a minor fall or trauma. The pain is moderate to severe and the child may be unable to bear weight.

Acute on chronic presents with a prolonged history of hip or knee pain and limp and sudden exacerbation with increased pain usually following a fall or trauma.

How is SCFE diagnosed?
Patient presents with inability to weight bear or a limp accompanied by clinical examination showing a decrease in internal rotation and flexion abduction. Lack of range of motion is accompanied by increased pain due to inflammation of the hip.

AP and frog lateral radiographs show the malalignment of the femoral head in relation to the femoral neck.

What is the treatment for SCFE?
The goal of treatment is stabilization of the hip and prevention of any further slippage. Treatment is immediate – within 24 hours – and is surgical. Surgery involves placement of a screw percutaneously which crosses the growth plate. Prognosis depends on the severity of the slip, early detection and prompt treatment.

What are possible complication of SCFE?
Chondrolysis, loss of articular cartilage, may cause the hip to lose motion and result in contracture and pain. Avascular necrosis occurs in 12% of patients at the time of the slip and disrupts the blood supply to the head of the femur.Progression of the slip may also occur.

What is the postoperative course?
Surgery occurs within 24-48 hours of diagnosis. The child uses crutches for six weeks with toe touch weight bearing. There are many follow up visits with the orthopaedist over the years which may include x-ray exams until the growth plate is fused. Child will be restricted from sports for six months.