What is slipped capital femoral epiphysis (✀SCFE ✁)?
Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.
How do you know if your child has slipped capital femoral epiphysis?
Stiffness in the hip Less movement than usual in the hip Children may not have had any injury before the pain starts. Diagnosing Slipped Capital Femoral Epiphysis When your child comes to our clinic, we examine them.
What is the epiphysis of the femur?
The epiphysis at the upper end of the femur is the growth center that eventually becomes the femoral head. SCFE is the most common hip disorder in adolescents. In SCFE, the epiphysis, or head of the femur, slips down and backward off the neck of the bone at the growth plate, the weaker area of bone that has not yet developed.
Where does the head of the femur slip down?
In SCFE, the epiphysis, or head of the femur, slips down and backward off the neck of the bone at the growth plate, the weaker area of bone that has not yet developed. An illustration and X-ray of a left SCFE. The femoral head has shifted slightly downward off the neck of the bone through the growth plate (arrow).
What is Skiffy surgery?
During surgery for SCFE, the doctor will probably reposition the slip in the hip. Then, the doctor will make a small cut (incision) near your child's hip. The doctor will put a metal screw through the bone and the growth plate in the cap of the femoral head. This helps make the bone stable.
What is SCFE in hip?
Slipped capital femoral epiphysis (SCFE) a disorder of adolescents in which the growth plate is damaged and the femoral head moves (“slips”) with respect to the rest of the femur.
Is SCFE serious?
An unstable SCFE is a more severe slip. Usually, it happens suddenly and is much more painful than stable SCFE. A child won't be able to walk at all on the affected side. An unstable SCFE is also more serious because it can restrict blood flow to the hip joint, leading to tissue death in the ball.
Is a SCFE a fracture?
A SCFE is actually a fracture of the growth plate. The fracture is usually a fairly stable one, and the slippage occurs very slowly.
What happens if SCFE goes untreated?
Untreated SCFE may result in progressive deformity and pain, destabilization of the femoral epiphysis, and decreased range of motion of the hip joint.
Does SCFE lead to hip replacement?
In some patients residual SCFE deformity is associated with advanced osteoarthritis and the only effective treatment may be a total hip replacement.
What is the recovery time for SCFE surgery?
The majority of patients with a slipped capital femoral epiphysis will be able to return to most sports and activities at approximately 3-6 months post-operatively. Removing the hardware is not necessary unless the patient develops pain or there is a problem with the screw itself.
Can SCFE heal on its own?
Early in the disease process, the body is sometimes able to heal itself by making new bone and strengthening the connection. Your child may then go weeks, months, or even years before the next episode of pain. Even more interesting is that some children grow into adulthood before they develop any hip pain.
How long does SCFE surgery take to perform?
When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, your child will not be allowed to put weight on their hip and will probably be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours.
Can you walk after SCFE surgery?
What happens after surgery? After surgery to fix a SCFE, the child will need to walk with crutches for 6 to 8 weeks. The child may be referred to a physical therapist for treatment during recovery. Follow-up is vital every 3 to 4 months for the next several years to recheck the treated hip.
What does SCFE feel like?
What are the symptoms of SCFE? Children with SCFE feel pain in the groin, the thigh, or sometimes only the knee. They will often have a limp. They also may have stiffness in the hip and a limited range of motion, especially when trying to turn the leg inward.
What is the most common age range for slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a condition typically affecting adolescents, during the period of rapid growth, from 10-15 years of age.
What is the recovery time for SCFE surgery?
The majority of patients with a slipped capital femoral epiphysis will be able to return to most sports and activities at approximately 3-6 months post-operatively. Removing the hardware is not necessary unless the patient develops pain or there is a problem with the screw itself.
How do you know if you have SCFE?
Signs and symptoms Symptoms of SCFE typically include complaints of pain in the groin or hip that is aggravated by activity. Sometimes the child will also experience pain in the thigh or knee area. In acute or unstable slips, the child will complain of immediate pain, limp, or feel like the leg is "giving way."
Can SCFE heal on its own?
Early in the disease process, the body is sometimes able to heal itself by making new bone and strengthening the connection. Your child may then go weeks, months, or even years before the next episode of pain. Even more interesting is that some children grow into adulthood before they develop any hip pain.
What does SCFE feel like?
What are the symptoms of SCFE? Children with SCFE feel pain in the groin, the thigh, or sometimes only the knee. They will often have a limp. They also may have stiffness in the hip and a limited range of motion, especially when trying to turn the leg inward.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis, or SCFE, (pronounced 'skiffy') is a hip condition seen in children who are still growing. With SCFE, the head of the femur, or epiphysis, slips down and backwards off the neck of the bone at the growth plate which has not fully developed yet. SCFE results in pain, stiffness, and hip instability. Without early detection and proper treatment, serious complications can result.
How to treat a femur slipping?
Treatment is accomplished through surgery, with the goal to prevent the head of the femur from slipping any further. Early diagnosis and treatment promotes the optimal outcome of hip stabilization, preserving long-term hip function, and preventing the development of further serious complications.
What are the symptoms of SCFE?
When unstable or more severe SCFE occurs, symptoms may include sudden onset of pain, and inability to walk or bear weight on the affected leg. Other symptoms that may be exhibited are leg length discrepancy or external or outward turning of the involved leg.
How long does SCFE pain last?
Some of the symptoms include complaints for weeks or months of intermittent pain in the groin, hip, knee, or thigh. The pain will typically become worse with activity with the child often exhibiting a limp when walking or running.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis ( SCFE or skiffy, slipped upper femoral epiphysis, SUFE or souffy, coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur ( metaphysis ). Normally, the head of the femur, called the capital, ...
Which hip is more affected by a sprain?
The left hip is more often affected than the right. Over half of cases may have involvement on both sides (bilateral).
What is the most common hip disorder in adolescence?
It is actually the metaphysis (neck part of a bone) which slips in an anterior direction with external rotation . SCFE is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain.
What is a SCFE fracture?
SCFE is a Salter-Harris type 1 fracture through the proximal femoral physis. Stress around the hip causes a shear force to be applied at the growth plate. While trauma has a role in the manifestation of the fracture, an intrinsic weakness in the physeal cartilage also is present.
What causes SCFE?
Cause. In general, SCFE is caused by increased force applied across the epiphysis, or a decrease in the resistance within the physis to shearing . Obesity is the by far the most significant risk factor. A study in Scotland looked at the weight of 600,000 infants, and followed them up to see who got SCFE.
How to tell if you have a SCFE?
Signs of a SCFE include a waddling gait, decreased range of motion. Often the range of motion in the hip is restricted in internal rotation, abduction, and flexion. A person with a SCFE may prefer to hold their hip in flexion and external rotation.
Where does a fracture occur in the hip?
The fracture occurs at the hypertrophic zone of the physeal cartilage. Stress on the hip causes the epiphysis to move posteriorly and medially. By convention, position and alignment in SCFE is described by referring to the relationship of the proximal fragment (capital femoral epiphysis) to the normal distal fragment (femoral neck). Because the physis has yet to close, the blood supply to the epiphysis still should be derived from the femoral neck; however, this late in childhood, the supply is tenuous and frequently lost after the fracture occurs. Manipulation of the fracture frequently results in osteonecrosis and the acute loss of articular cartilage ( chondrolysis) because of the tenuous nature of the blood supply.
What is the hip joint?
The hip is a ball (femoral head) and socket (acetabulum) joint. Smooth cartilage covers the surfaces of the socket and the femoral head which allows for easy, comfortable movement of the hip. Slipped capital femoral epiphysis or SCFE (pronounced skiffy) is a disorder of the hip that occurs in adolescents when the top of the thigh bone (femoral epiphysis) slips out of place.
How Does SCFE Occur?
In the most typical scenario, SCFE starts gradually, but it can also have an abrupt onset. It may be the result of an accident or fall, but it is not unusual for there to be no obvious precipitating injury.
What Causes SCFE?
SCFE occurs during adolescence when the growth plates remain open. It appears that SCFE is more likely to develop during growth spurts. Boys are slightly more likely than girls to develop SCFE. This disorder is associated with adolescents who:
Why is SCFE diagnosed?
Diagnosis by an expert is often needed, because SCFE is an unusual disorder. Rapid diagnosis leads to rapid treatment, which may improve outcomes. Parents who notice symptoms of pain, limping, or reduced mobility in their children should seek expert care at once.
What is residual SCFE?
Many patients with a SCFE in adolescence have a residual deformity that can cause hip pain and eventual osteoarthritis. The residual SCFE deformity is known to cause secondary femoroacetabular impingement (FAI). Many patients with residual deformity present with hip problems between the ages of 15 and 30 years. Treatment of residual SCFE deformities can be successful in relieving pain, improving function and increasing activity level. In some patients residual SCFE deformity is associated with advanced osteoarthritis and the only effective treatment may be a total hip replacement. Reconstructive hip surgery for residual SCFE deformities can be complex and is best performed by a surgeon with specific interest and expertise in this area.
What causes a slip in the femoral physis?
In general, the slip is caused by an inability of the proximal femoral physis to resist physiologic loads. Endocrinopathies that weaken the physis are thought to be responsible for 5% to 8% of SCFE cases.
What happens when you flex your hips in SCFE?
Following this migration, hip flexion may cause impingement of the anterior femoral metaphysis leading to cyst formation, damage to the labrum or acetabular cartilage, and other degenerative changes.
Why is in situ fixation important for stable slips?
Both stable and unstable SCFE require surgical management in order to prevent slip progression. In situ fixation is performed in most cases. Forceful manipulation is never recommended as this may increase the risk of osteonecrosis. This is particularly important for stable slips which, by definition, cannot be easily reduced.
What is SCFE in adolescence?
SCFE is most commonly (but not exclusively) seen in overweight, adolescent males. SCFE is usually treated with percutaneous pin fixation, to prevent further slippage. Figure 1: A slipped capital femoral epiphysis of the left hip is shown on the radiograph.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE, pronounced “skiffy”) occurs when there is abnormal movement of the femoral metaphysis relative to the epiphysis along the physis ( growth plate). Thus, SCFE is technically a growth plate fracture. Because the femoral head is secured by the acetabulum, a sufficiently large force applied across ...
What are the pathologic changes in SCFE?
Several studies have revealed pathologic physeal changes in SCFE, including replacement of the normal growth plate with abnormal cartilaginous and fibrous tissue. There may be widening of the physis along with hypocellularity and loss of columnar organization. The slip generally occurs through the proliferative and hypertrophic zones of the physis, the site where chondrocytes and normal components may have been replaced by ground substance. After fixation and stabilization of the slip, these pathologic findings seem to revert to more normal structure, at least partially.
How long do scfe symptoms last?
Symptoms may have persisted for days or weeks prior to the child’s initial presentation. Both hips must be evaluated, as many cases of SCFE initially present with bilateral disease.
What does it mean when your hip is stiff?
Hip stiffness is the feeling that your hip joint doesn’t move as easily as it once did , and it’s generally painful. You may feel as if your hip is clicking or popping as you move. Your range of motion may also be affected. Sometimes hip stiffness may make you move more slowly than you used to.
What causes stiff hips?
Stiff hips may be the result of a short-term injury or part of a chronic, debilitating condition.
How are stiff hips diagnosed?
Your doctor may diagnose a stiff hip by taking your medical history, performing a physical examination, and taking imaging scans.
Why does my hip feel stiff after exercising?
You also may experience hip stiffness after exercising due to tight hip flexor muscles. The flexor muscles are a collection of muscles that help you lift your knees while bending at the waist. Tight flexor muscles are usually a temporary condition.
How to treat a stiff hip?
Examples of at-home treatments for a stiff hip include: applying heat or ice to the affected hip with a covering to prevent burns or frostbite. performing physical or occupational therapy exercises at home to improve mobility. resting the affected or painful hip joint. stretching the hip muscles to reduce tension.
How to relieve stiffness in hip?
stretching the hip muscles to reduce tension. taking anti-inflammatory medications, such as naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin), which can also allevia te the pain. Your doctor may prescribe stronger medications if these treatments aren’t enough to relieve hip stiffness.
How to prevent hip stiffness?
However, maintaining a healthy weight can reduce the stress and strain placed on your hips. Warming up, stretching, and cooling down properly when exercising can help prevent a stiff hip. Last medically reviewed on November 26, 2019.
What is SCFE in hip?
SCFE is a shift at the upper part of the thighbone, or femur, that results in a weakened hip joint. Fortunately, when caught early, most cases of SCFE can be treated successfully.
Why are the hip and thigh bones less connected?
But in some kids — particularly those who are obese — the thighbone and the hipbone are a little less well connected than they should be because of a condition called slipped capital femoral epiphysis (SCFE). SCFE is a shift at the upper part of the thighbone, or femur, that results in a weakened hip joint. Fortunately, when caught early, most ...
What is SCFE in children?
Usually, SCFE is classified as: 1 Stable SCFE. A stable SCFE causes some stiffness or pain in the knee or groin area, and possibly a limp that causes a child to walk with a foot outward. The pain and the limp usually tend to come and go, worsening with activity and getting better with rest. With stable SCFE, a child still can walk, even if crutches are needed. 2 Unstable SCFE. An unstable SCFE is a more severe slip that usually happens suddenly, and is usually much more painful. A child will not be able to bear weight on the affected side. An unstable SCFE is also more serious because it can restrict blood flow to the hip joint, leading to tissue death in the head of the femur.
Why is SCFE so bad?
An unstable SCFE is also more serious because it can restrict blood flow to the hip joint, leading to tissue death in the head of the femur. Sometimes SCFE can irritate the nerves that run down the leg, causing referred pain (pain that starts in one part of the body but is felt in another).
What is the ball and socket joint?
The hip is a ball-and-socket joint, which means that the rounded end of one bone (in this case, the "ball" of the thighbone) fits into the hollow of another bone (the acetabulum, or cup-shaped "socket" of the pelvis). Ball-and-socket joints offer the greatest range of movement of all types of joints, which explains why we can move our legs forward, ...
Where is the growth plate on the thigh?
Kids and teens who are still growing also have a growth plate at the top of the thighbone, just under the "ball" portion (also known as the femoral head) of the joint. This growth plate is called the physis and it's made of cartilage, which is weaker than bone.
Can a child walk with a stable SCFE?
With stable SCFE, a child still can walk, even if crutches are needed. Unstable SCFE. An unstable SCFE is a more severe slip that usually happens suddenly, and is usually much more painful. A child will not be able to bear weight on the affected side.
What is the ball and socket of the hip?
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). (Left) Normal anatomy of the hip. (Right) The location of the growth plates and epiphyses at the ends of the femur (thighbone).
Where does the femur grow?
Instead, growth occurs at each end of the bone around an area of developing cartilage called the growth plate (physis).
Why is SCFE more common in boys than girls?
The cause of SCFE is not known. The condition is more likely to occur during a growth spurt and is more common in boys than girls. Risk factors that make someone more likely to develop the condition include: Excessive weight or obesity—most patients are above the 95th percentile for weight. Family history of SCFE.
What are the complications of SCFE?
Complications following SCFE include avascular necrosis (degeneration of the femoral head), chondrolysis (rapid onset of painful arthritis), and impingement.
What is the most common hip disorder in adolescents?
SCFE is the most common hip disorder in adolescents. In SCFE, the epiphysis, or head of the femur (thighbone), slips down and backwards off the neck of the bone at the growth plate, the weaker area of bone that has not yet developed.
How to treat SCFE?
Procedures used to treat SCFE include: In situ fixation. This is the procedure used most often for patients with stable or mild SCFE. The doctor makes a small incision near the hip, then inserts a metal screw across the growth plate to maintain the position of the femoral head and prevent any further slippage.
What is the treatment for SCFE?
The condition usually develops gradually over time and is more common in boys than girls. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further.
How to tell if a teen has slipped capital femoral epiphysis?
Symptoms of slipped capital femoral epiphysis include: Pain in your teen’s groin, knee or hip. Stiffness in your teen’s hip. Foot/leg that is turned outward. Walking with a limp. Can’t put weight on the leg (usually in more severe cases and with extreme pain). One leg may look shorter than the other.
What happens when the head of the femur slips off the neck of the bone at the growth plate?
Slipped capital femoral epiphysis happens when the head of the femur slips off the neck of the bone at the growth plate.
What are the complications of a femoral head slipping?
Major complications are avascular necrosis and chondrolysis. Avascular necrosis is a serious complication that happens if your teen’s femoral head has severely slipped. When this happens, the blood supply to the head of the femur is cut off and the hip begins to collapse. This results in rapid and severe osteoarthritis. Reconstructive hip surgery is often needed. Chondrolysis is a condition that happens when there is a sudden and severe destruction of cartilage in the hip joint.
What is a scfe?
Slipped Capital Femoral Epiphysis (SCFE) Slipped capital femoral epiphysis (SCFE) is a hip disorder. The head of the femur slips off the neck of the bone at the growth plate. Typically, SCFE occurs in overweight children between 11 and 16 years old.
Where is the SCFE bone located?
The growth plate is where new bone forms. It’s located in the ‘neck’ area of the femur between the “ball” section and the long shaft section of the femur.
How to diagnose SCFE?
SCFE is diagnosed through physical exam including rotation of the affected leg, observation while walking and X-rays. A MRI may be ordered if the diagnosis is not able to be made with X-rays and your healthcare provider still suspects your child has SCFE. Your provider may also order blood work to check for other medical conditions.
What is unstable SCFE?
Unstable SCFE: This type is more severe. Your child will not be able to put weight on the affected leg . This type tends to happen suddenly and is more painful. It can also lead to more serious complications.
What is a hip femoral epiphysis?
Slipped Capital Femoral Epiphysis (SCFE) is a hip condition that occurs when the ball at the top of the thigh bone (also known as the femoral head) slips backwards, away from the lower portion of the thigh bone.
What is a slipped capital femoral epiphysis?
What is Slipped Capital Femoral Epiphysis (SCFE)? Slipped Capital Femoral Epiphysis (SCFE) is a hip condition that occurs when the ball at the top of the thigh bone (also known as the femoral head) slips backwards, away from the lower portion of the thigh bone. SCFE usually occurs in one hip, but both hips can be affected in 20 ...
What is the purpose of physical therapy after hip surgery?
After surgery, physical therapy typically helps children strengthen the hip and leg muscles and regain mobility. We usually monitor the unaffected hip to ensure that SCFE does not develop.
How long does it take for SCFE to develop in the other hip?
Once SCFE is found in one hip, the greatest risk for developing it in the other hip is within 18 months.
How to correct SCFE?
Surgery typically involves making an incision near the hip. To prevent additional slipping, Gillette specialists stabilize the femoral head and growth plate with screws and pins.
What tests are used to diagnose SCFE?
At Gillette Children’s Specialty Healthcare, diagnosis typically includes a review of your child’s medical history, a physical exam and one or a combination of tests to look for SCFE: X-ray. MRI. Bone scan.
Why does SCFE occur?
The exact cause of SCFE is unknown. It often develops during rapid growth in adolescence, most likely because of weakness in the growth plate.
Overview
Slipped capital femoral epiphysis (SCFE or skiffy, slipped upper femoral epiphysis, SUFE or souffy, coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (metaphysis).
Normally, the head of the femur, called the capital, should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip. The term slipped capital femoral …
Signs and symptoms
Usually, a SCFE causes groin pain, but it may cause pain in only the thigh or knee, because the pain may be referred along the distribution of the obturator nerve. The pain may occur on both sides of the body (bilaterally), as up to 40 percent of cases involve slippage on both sides. In cases of bilateral SCFEs, they typically occur within one year of each other. About 20 percent of all cases include a SCFE on both sides at the time of presentation.
Cause
In general, SCFE is caused by increased force applied across the epiphysis, or a decrease in the resistance within the physis to shearing. Obesity is the by far the most significant risk factor. A study in Scotland looked at the weight of 600,000 infants, and followed them up to see who got SCFE. This study identified that obese children had an almost twenty times greater risk than thin children, with a 'dose-response'- so the greater the weight of the child, the greater the risk of SCF…
Pathophysiology
SCFE is a Salter-Harris type 1 fracture through the proximal femoral physis. Stress around the hip causes a shear force to be applied at the growth plate. While trauma has a role in the manifestation of the fracture, an intrinsic weakness in the physeal cartilage also is present. The almost exclusive incidence of SCFE during the adolescent growth spurt indicates a hormonal role. Obesity is another key predisposing factor in the development of SCFE.
Diagnosis
The diagnosis is a combination of clinical suspicion plus radiological investigation. Children with a SCFE experience a decrease in their range of motion, and are often unable to complete hip flexion or fully rotate the hip inward. 20–50% of SCFE are missed or misdiagnosed on their first presentation to a medical facility. SCFEs may be initially overlooked, because the first symptom is knee pain, referred from the hip. The knee is investigated and found to be normal.
Treatment
The disease can be treated with external in-situ pinning or open reduction and pinning. Consultation with an orthopaedic surgeon is necessary to repair this problem. Pinning the unaffected side prophylactically is not recommended for most patients, but may be appropriate if a second SCFE is very likely.
Once SCFE is suspected, the patient should be non-weight bearing and remain on strict bed rest. …
Epidemiology
SCFE affects approximately 1–10 per 100,000 children. The incidence varies by geographic location, season of the year, and ethnicity. In eastern Japan, the incidence is 0.2 per 100,000 and in the northeastern U.S. it is about 10 per 100,000. Africans and Polynesians have higher rates of SCFE.
SCFEs are most common in adolescents 11–15 years of age, and affects boys more frequently t…
See also
• Legg–Calvé–Perthes syndrome – another cause of avascular necrosis of the femoral head, seen in younger children than SCFE
• Hip dysplasia
• Drehmann sign – Clinical test examining for SCFE
Structure and Function
Objective Evidence
Epidemiology
Differential Diagnosis
Red Flags
Treatment Options and Outcomes
Risk Factors and Prevention
- Though the specific cause of SCFE is often unknown, a number of factors are thought to increase the risk of a slip. These include obesity, endocrinopathies, renal osteodystrophy, prior radiation therapy, and anatomic abnormalities of the hip joint. Among patients with an endocrine abnormality, SCFE is 6 to 8 times more prevalent than it is in the g...
Miscellany
Skills