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.
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.
What is capital femur epipyhsis treatment?
Slipped capital femoral epipyhsis Treatment. The goal for treatment is to prevent the femoral head from slipping any further and to avoid complications. This is accomplished with surgery. A screw is inserted to connect the femoral head with the rest of the femur.
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).
Is slipped capital femoral epiphysis 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.
How is slipped capital femoral epiphysis treated?
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 does a slipped capital femoral epiphysis feel like?
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."
How common is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. It usually occurs in children eight to 15 years of age, and it is one of the most commonly missed diagnoses in children.
What causes slipped femoral epiphysis?
The exact cause of SCFE is not known. There are, however, many factors that are associated with this condition. These factors lead to weakening of the growth plate (also called the “physis”) which then causes the femoral head (ball of the femur) to slip off the neck of the femur. Obesity is a major risk factor.
Does SCFE lead to hip replacement?
It is known that patients with SCFE are likely to need total hip arthroplasty (THA) sooner, with 45% of SCFE patients needing THA by age 50.
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.
Who gets a slipped capital femoral epiphysis?
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.
Is SCFE an emergency?
SCFE is not usually an emergency. Active children often complain of hip and knee pain.
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.
Is SCFE a disability?
SCFE occurs through the unfused growth plate of the proximal femur where the femoral head slips posteriorly on the femoral neck. Serious consequences of the problem, such as gait disturbance, post-traumatic arthritis, chondrolysis and osteonecrosis of the femoral head can occur, leading to lifelong disability.
What is a possible complication of capital femoral epiphysis?
Two most severe complications of slipped capital femoral epiphysis are avascular necrosis and chondrolysis. Avascular necrosis is more commonly associated with the acute slips when the lateral epiphyseal vessels are disrupted. In chronic slips, avascular necrosis can occur as a result of treatment.
How long does it take to recover from 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.
Is SCFE an emergency?
SCFE is usually an emergency and must be diagnosed and treated early. In 20 to 40 percent of affected children, SCFE will be present in both hips at the time the child is diagnosed. If only one hip is affected, the other hip will eventually slip 30 to 60 percent of the time. Treatment is surgical.
What is the modified Dunn procedure?
The modified Dunn procedure using the retinacular soft-tissue flap offers the opportunity to anatomically reduce a displaced femoral epiphysis while visually controlling the retinacular perfusion of the femoral head.
Who is most likely to suffer a slipped capital femoral epiphysis?
Who is at risk for developing slipped capital femoral epiphysis? Typically, SCFE occurs in overweight children between 11 and 16 years old and is more common in boys than girls. SCFE occurs more frequently in African Americans and Hispanic children than Caucasians.
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 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 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 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 are the two types of SCFE?
There are two types of SCFE, stable and unstable.
What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects adolescents. In SCFE, the head, or "ball," of the thigh bone (referred to as the femoral head) slips off the neck of the thigh bone. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. This condition causes the hip joint to become painful and stiff.
What is the procedure for SCFE?
Testing and diagnosis. In addition to a complete medical history and physical examination, diagnostic procedures for SCFE almost always include X-rays, which use invisible electromagnetic energy beams to produce images of the bone onto film.
What is the pain of SCFE?
Unstable: In this type of SCFE, the pain occurs suddenly, almost like a break. Pain is usually severe and patients can’t walk, not even with crutches. Because this type of SCFE occurs suddenly, the blood flow can be affected 20 to 50 percent of the time which can result in the bone dying ( avascular necrosis ).
What happens when a child slips?
The child with a chronic or stable slip usually walks with a limp, complains of hip pain, and reports that rest alleviates the pain. The child may also walk with his or her leg turned outward. As the slip progresses, the shape of the hip changes and it becomes stiffer and harder to bend and rotate the hip.
When does a scfe start?
SCFE develops most often during short periods of accelerated growth following the onset of puberty. SCFEs can be divided into two major types:
What are the risk factors for SCFE?
Risk factors that increase the likelihood of SCFE include the following: Risk factors may include: Obesity. Medications (such as steroids) Thyroid problems. Radiation treatment. Bone problems related to kidney disease.
Who determines the treatment for SCFE?
Specific treatment for SCFE will be determined by your child's doctor based on:
What is the goal of treatment for a displaced femoral head?
The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery.
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).
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.
What are the risk factors for SCFE?
Risk factors that make someone more likely to develop the condition include: 1 Excessive weight or obesity—most patients are above the 95th percentile for weight 2 Family history of SCFE 3 An endocrine or metabolic disorder, such as hyperthyroidism—this is more likely to be a factor for patients who are older or younger than the typical age range for SCFE (10 to 16 years of age)
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.
What Is Slipped Capital Femoral Epiphysis?
The slipped capital femoral epiphysis is a medical term that refers to the slippage of the epiphysis of the upper part of the femur from the hip socket. It is the neck along with the shaft that gets displaced from the hip socket in the front and upward direction. This condition is more common in adolescence during the rapid growth phase.
What Are the Causes of Slipped Capital Femoral Epiphysis?
The growth plate or the growth center of the femur is located between the epiphysis and the shaft of the femur. This growth center eventually becomes the femur head. During adolescence, the growth plate is the weaker area of the bone since it is not fully developed.
What Are the Symptoms of Slipped Capital Femoral Epiphysis?
The symptoms of slipped capital femoral epiphysis depend on the severity of the condition. The onset of symptoms is gradual and slowly progressive. Common symptoms are:
How to Diagnose Slipped Capital Femoral Epiphysis?
Diagnosis is based on the patient's symptoms and radiological findings.
How to Treat Slipped Capital Femoral Epiphysis?
The treatment of slipped capital femoral epiphysis aims to prevent further slip, reduce the displacement and avoid complications. Conservative management involves rest, over-the-counter painkillers, non-weight-bearing activities, physical therapy, and traction. In most cases, surgery is the choice of treatment.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a hip condition that affects older children and teenagers. It occurs when the epiphysis (head) of the femur (thighbone) slips off the neck of the bone. This happens at the growth plate.
How is SCFE treated?
This will help to prevent future health problems, such as arthritis. Surgery will be done to insert 1 or 2 metal screws through the growth plate. This will help to keep the head of the femur from moving out of place.
What causes or increases the risk for SCFE?
It is not known what causes SCFE. It commonly occurs during rapid periods of growth. It may occur after a fall or sports injury. Obesity and a family history of SCFE increase your child's risk of developing SCFE. Endocrine disorders, such as hyperthyroidism, also increase your child's risk.
How is SCFE diagnosed?
The provider will examine your child's affected hip and leg. He or she will also observe the way your child walks. X-rays or CT scans of your child's pelvis, hip, and thigh may show the SCFE. Your child may be given contrast liquid to help his or her hip bones show up better in the pictures. Tell the healthcare provider if your child has ever had an allergic reaction to contrast liquid.
Can a fall cause SCFE?
It may occur after a fall or sports injury. Obesity and a family history of SCFE increase your child's risk of developing SCFE. Endocrine disorders, such as hyperthyroidism, also increase your child's risk.
What are the symptoms of slipped capital femoral epiphysis?
pain in the hip that’s aggravated by activity and that may subside with rest
What causes slipped capital femoral epiphysis?
In pre-adolescent and adolescent growth and development, a child is growing quickly as adult hormones begin to circulate in his or her system. The growth plate (the area at the end of bone responsible for growth, which is not as strong as bone) gets weaker because it’s broadening.
How we care for SCFE
The Child and Young Adult Hip Preservation Program at Boston Children's Hospital treats both common and complex hip disorders. As the first program in the country to focus on hip disorders in children and young adults, we are experts in diagnosis and treatment of SCFE and other hip problems.
Patient resources
Download our patient fact sheet for SCFE to learn more about this condition and how the hip specialists in Boston Children’s Child and Young Adult Hip Preservation Program provide comprehensive care throughout each patient’s treatment.
How is slipped capital femoral epiphysis diagnosed?
At Boston Children's Hospital, we know that the first step to treating your child’s slipped capital femoral epiphysis (SCFE) is to form a complete and accurate diagnosis.
How is slipped capital femoral epiphysis treated?
The goal of treatment is to prevent the femoral head from further slippage, to avoid complications and eliminate hip impingement, which can cause arthritis later in life.
Long-term outlook for a child with slipped capital femoral epiphysis
Success rates are high for SCFE treatment at Boston Children’s. Treating your child’s hip as soon as symptoms develop greatly increases the likelihood of a successful outcome. Most children treated for SCFE at Boston Children’s have treatments that enable them walk, play, grow and live active lives.
What is a slipped capital femoral epiphysis and what causes it?
A slipped capital femoral epiphysis occurs when the upper, or capital, epiphysis of the thigh bone (femur) slips sideways off the end of the shaft. You can find out more about the structures around the hip and why this happens at the bottom of this leaflet.
What are the symptoms of a slipped capital femoral epiphysis?
The symptoms can vary depending on whether the slip is sudden (acute) or has been going on for a while (chronic). Hip or groin pain is usually the main symptom.
How to tell if a child has a slip?
In a chronic slip, symptoms tend to be more mild and come on gradually. Pain is usually felt in the groin or around the hip. Sometimes pain can be felt in the knee or lower thigh rather than the hip. This is called 'referred' pain. The pain is 'referred' along nerves from the hip to the knee or the lower thigh. This can sometimes be misleading and, in some cases, the diagnosis of slipped capital femoral epiphysis can be missed and the symptoms put down to a knee problem. Your child will still be able to walk but you may notice that they limp and find walking may be painful. Pain can be made worse by running, jumping or other activities. Your child may complain of stiffness in their hip joint. Again, the leg on the affected side may appear shorter. You may also notice that the muscles in your child's thigh start to become less strong and look less bulky (wasted) if they have a chronic slip.
Why is a slipped capital femoral epiphysis more common in overweight children?
In fact, rates may be increasing due to rising levels of childhood obesity. It is much more likely to affect boys than girls; three boys are affected for every two girls.
What happens if a child slips his leg?
One complication is avascular necrosis. In this condition, the blood supply to the ball (the head) of the thigh bone (femur) is damaged due to the slipped epiphysis. This most commonly happens after a sudden (acute) slip. It can also sometimes be a complication of surgery. Your child will usually complain of pain in their groin or knee and they will not be able to move their hip as much as normal. Crutches are usually suggested so that the weight is taken off your child's affected leg. Physiotherapy and painkillers may also help. In severe cases of avascular necrosis, either the bones around the hip joint are fused together or a hip replacement may be needed.
What is the epiphysis of the hip?
There is an epiphysis at each end.) It most commonly affects older and teenage boys (adolescents) who are overweight. Pain in the hip or knee and limping are the main symptoms. It can be diagnosed on an X-ray. Treatment usually involves surgery to stop the epiphysis from being able to move.
Which epiphysis is closest to the hip?
In the femur, the epiphysis that is nearest to the hip is called the upper, or capital, femoral epiphysis.
What is slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a hip problem. It starts if the epiphysis (growing end) of the femur (thigh bone) slips from the ball of the hip joint. SCFE may develop in one or both legs.
What is the procedure for SCFE?
This is a doctor who fixes bone problems. The most common surgery of SCFE is called “in-situ fixation.”. With this treatment, the bone is held in place with a screw. This screw keeps the thigh bone from slipping and will close the growth plate.
What is stable SCFE?
A child is considered to have “stable” SCFE if he or she can walk with or without crutches. More than 90% of cases of SCFE are stable. A child who has stable SCFE may first have stiffness in the hip. The stiffness may get better with rest. After a while, the stiffness may turn into a limp.
How long does it take for a child to walk after a hip replacement?
Some children who have had SCFE may get arthritis in the hip later in life. If your child has surgery, it will take time to get better. For 4 to 6 weeks after surgery, your child will need to use crutches to walk. Then your child can slowly get back into normal activities.
What are the complications of SCFE?
The most serious complications are avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of cartilage). Your doctor can explain these issues to you, if needed.
When does SCFE occur?
SCFE usually occurs in children between the ages of 8 and 15 years old. It often happens during a growth spurt. It’s also more common in children who have a family history of SCFE. More boys than girls get SCFE. It’s more common in blacks than whites. Obese children have a much higher risk of getting SCFE.
Can a child's hip be limping?
The stiffness may get better with rest. After a while, the stiffness may turn into a limp. The child may have pain that comes and goes. The pain is often felt in the groin, the thigh, or the knee, and not in the hip itself. Later, the child may lose some ability to move the involved hip.
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, ...
Where is the capital of the femur?
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 epiphysis is actually a misnomer, because the epiphysis (end part of a bone) remains in its normal anatomical position in the acetabulum (hip socket) ...
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.
How long does it take for a SCFE to occur?
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.
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.
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.