Slipped Capital Femoral Epiphysis (SCFE)

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents causing slippage or separation of the femoral head (ball at the upper end of the femur bone) from the weakened epiphyseal growth plate (growing end of the bone).This condition often develops during the rapid growth period after the onset of puberty, and may affect one or both legs at a time. The separation may be caused by an injury or other factors such as obesity and hormonal imbalances. SCFE commonly occurs in children between 11 and 15 years and boys are more likely to develop the condition than girls.

Causes and Risk Factors

The exact cause of SCFE remains unclear; however, the presence of certain factors may increase the risk of your child developing this condition. These include:

• Obesity: SCFE is more common in children who are obese and have rapid growth. This may be attributed to excess pressure on the growth plate
• Endocrine disorders such as diabetes, thyroid disease and  growth hormone abnormalities (acromegaly)
• Kidney diseases
• Radiation therapy or chemotherapy for childhood leukemias
• Steroid medications
• Family history of the disorder

Types

SCFE is classified into two types, stable and unstable SCFE, based on the severity of pain and damage.

• Stable SCFE (mild slip): The condition is considered mild or stable if the child is having pain or stiffness in the knee or groin area but can manage to walk and may limp. Symptoms worsen with activity and subside with rest. In stable SCFE the child is able to walk with or without the help of crutches
• Unstable SCFE (severe slip): Any major blow such as a fall or sports injury may cause unstable SCFE. The child may have severe pain and stiffness that may limit movement. The child may not be able to walk or even put weight on the affected side

Diagnosis

Your doctor will diagnose the condition based on a careful medical history and physical examination where the walking pattern and hip movements will be monitored. X-rays of the hip confirm the diagnosis. Other imaging tests that may be ordered include:

• Bone Scanning: Bone scans help in the early detection of children at risk of avascular necrosis and chondrolysis, common complications of SCFE
• Computed Tomography Scan: Computed Tomography (CT) scans reveal the degree of slippage
• Ultrasonography: Ultrasound scan helps to distinguish between stable and unstable slip
• Magnetic Resonance Imaging Scan: Magnetic resonance imaging (MRI) scan may suggest possible complications such as avascular necrosis