Slipped Capital Femoral Epiphysis or SCFE

Slipped capital femoral epiphysis or SCFE is a type of progressive disorder of the hip joint, which is more common among pre-teens and teens. Slipped capital femoral epiphysis/SCFE is a condition in which femoral head epiphysis or the head of the thigh bone slips off the neck of the thigh bone due to weak epiphysis present in the upper edge of the thigh bone.

Slipped capital femoral epiphysis is a condition, which results in fracturing of the epiphysis or the growth plate. This fracture is quite stable in nature and slippage takes place gradually. However, in some cases this gradual slippage may also become unstable and the head of the thigh bone slips off completely resulting in severe deformity and problems with blood supply to the head of the thigh bone. Therefore, slipped capital femoral epiphysis must be treated as soon as possible in order to prevent any severe deformities.^[1]

Slipped capital femoral epiphysis may also lead to pain at the side or in front of the hip, although the pain may also be felt in the knee or the thigh. It is commonly seen that a child affected with slipped capital femoral epiphysis may not have any pain, but present with an out-toeing gait with a limp.^[2]

Slipped capital femoral epiphysis is often mistaken for groin pull. It is however noteworthy that children and adolescents almost never suffer with any groin pulls, hence if a hip problem is noted which seems to be related to the muscles in the groin, the person should be immediately diagnosed for slipped capital femoral epiphysis.

Boys are two to three times more prone to slipped capital femoral epiphysis when compared to girls.^[3]

Slipped capital femoral epiphysis or SCFE is broadly classified into two types:

1. Stable Slipped capital femoral epiphysis, which involves slow slipping of the epiphysis.
2. Unstable Slipped capital femoral epiphysis, which involves sudden slipping of the ball part of the hip which causes severe pain and inability to walk.^[4]

Slipped capital femoral epiphysis is an injury, which may be caused due to fracture of the neck of the femur or the thigh bone. This fracture develops slowly over a period of time by forcing the two parts of the bone to slip apart in order to separate them leaving the head of the femur moved in the backward direction.

Although the exact cause of slipped capital femoral epiphysis is still not known, the suspected causes may include:^[5]

• Weakness in the bone due to hormone imbalances such as low thyroid hormone.
• Overweight.
• Minor fall.
• Trauma.
• Family history of hip conditions can also be a likely cause of Slipped capital femoral epiphysis.

• Pain in the hip or groin that may radiate down into the knee is one of the symptoms of slipped capital femoral epiphysis.
• Limited range of motion of the leg while moving sideways when compared to the other side.
• External rotation of the leg.
• Limp.
• Limitation in rotation of the hip in sideward direction is also one of the symptoms of slipped capital femoral epiphysis.^[6]

Slipped capital femoral epiphysis or SCFE needs to be treated as early as possible to prevent potential death of the femoral head. Surgery needs to be done to prevent any additional slipping of the head of the femur until the growth plate closes.

Surgery involves fixing the head of the femur with the help of pins or screws.

Surgery for slipped capital femoral epiphysis may be of three types each of which is performed depending upon the severity of the case:

• Inserting a single screw into the femoral epiphysis and thighbone.
• Decreasing the displacement and inserting one or two screws into the head of the femur.
• Removing the abnormal epiphysis and inserting screws in order to prevent any further displacement.^[7]

Patients with slipped capital femoral epiphysis may have to use crutches for about 6 to 8 weeks after surgery to avoid bearing weight on the affected leg. Physical therapy will be required for balance, strengthening, endurance training, and proprioception. Patient may gradually return back to sports activities only when the condition is pain free, but it is advisable not to return to any contact sports until the physis is closed completely. Regular follow up and radiographic tests are required to be done to be sure that slippage has not progressed.

A complete physical examination is performed to diagnose slipped capital femoral epiphysis. Physical examination often exhibits limited range of motion of the hip, complete loss of hip flexion and inability to fully rotate the hip inward. Inflammation in the hip results in pain at the extremes of motion, muscle spasm, and involuntary muscle guarding.

Typically, an x-ray helps in confirming the diagnosis of slipped capital femoral epiphysis.^[8]

References:

Also Read:

• Hip Bursitis or Trochanteric Bursitis: Causes, Symptoms, Treatment, Exercises
• What is Hip Dislocation?|Types, Treatment, Exercises for Hip Dislocation
• Hip Flexor Strain: Types, Causes, Symptoms, Treatment. Exercise, Recovery
• Hip Sprain: Causes, Symptoms, Treatment, Exercises
• Labral Tear of the Hip Joint