What is a slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) is a fracture through the growth plate where the head of the femur (thigh bone) slips off the femoral neck. Children describe experiencing pain in the hip, thigh, or knee. Severe pain can occur suddenly – acutely, or it can be milder and last for a longer period – chronically. SCFE can range from mild, where children can still walk, to severe, where walking becomes impossible. SCFE typically occurs during the pubertal growth spurt, with an increased frequency in overweight children and those intensely involved in activities that involve jumping. The upper end of the femur in children is constructed in a way that the growth plate is positioned quite perpendicular to the surface, exposing the growth plate to significant shear forces. Another significant factor contributing to SCFE is hormonal imbalance – an unfavorable ratio of hormones affecting growth compared to those affecting the maturation of the growth plate. SCFE occurs somewhat more frequently in boys, and in 25% of cases, it affects both hips simultaneously.

In pubescent children, if sudden and severe hip pain, restricted mobility, or an inability to walk occur, suspicion of SCFE is warranted, requiring an urgent examination by a pediatric orthopedic surgeon. Concidering SCFE, making X-ray images, and carefully examining radiographs are crucial.

How to diagnose slipped capital femoral epiphysis?

After a consultation and a clinical examination of the child, suspicion of SCFE can arise. Children describe intense pain in the hip, thigh, or knee that occurred suddenly, usually after some activity. The pain can be so severe that the child limps or cannot walk. In chronic SCFE, the pain is not sudden and overly pronounced; instead, children complain of minor pain and discomfort in the hip or thigh to the knee. In the clinical examination, the child should lie on the examination table, and the range of motion in the hip should be checked. Hip flexion is altered – the knee “moves outward,” while internal rotation of the hip is extremely painful. An old rule in pediatric orthopedics is that in the case of all knee pain, the hips should also be examined. The basic diagnostic workup includes X-rays of the hips in two directions, where the X-ray images look for displacement of the femoral head concerning the neck, as shown in Figure 1. Sometimes, in minor and chronic SCFE, X-ray images are not sufficient, and an MRI may be necessary. Other conditions that can initially cause similar symptoms in the hip are transient synovitis of the hip, septic arthritis of the hip, stress fracture of the femoral neck, or juvenile idiopathic arthritis of the hip.


Figure 1.

How to treat slipped capital femoral epiphysis?

SCFE is always treated surgically – stabilization/fixation of the displaced femoral head with a screw, as shown in Figure 2. After surgery, the child should walk with partial weight-bearing using forearm crutches for six weeks. The operation should be performed as soon as possible to avoid a larger displacement of the femoral head. With a greater displacement of the femoral head, the chances of blood vessels leading to the head tearing, interrupting the blood supply to the femoral head, and gradually transitioning into avascular necrosis – infarction increase. This is a severe consequence of SCFE that causes significant pain and is resolved by the implantation of an artificial hip joint. Milder degrees of SCFE have a good prognosis after surgery, as bone remodeling in the neck can occur, resulting in a completely healthy hip shape. Unfortunately, sometimes, even after a successfully performed operation, the hip remains changed and has a higher chance of developing secondary osteoarthritis – wear of the joint cartilage over time.

SCFE post OP

Figure 2.

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