Slipped Capital Femoral Epiphysis
Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents causing slippage or separation of the femoral head (ball-shapped 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.
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 leukemia
- Steroid medications
- Family history of the disorder
Types of SCFE
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.
Signs and Symptoms
Children with SCFE will exhibit certain characteristic symptoms that may even help the physician in assessing the type of SCFE. The signs and symptoms of stable SCFE include:
- Stiffness in the hip
- Pain in the groin, the thigh or the knee that lasts from several weeks to months
- Limping while walking
- Restricted movements of the hip
- Outward twisting of the leg
The signs and symptoms of unstable SCFE include:
- Severe pain similar to that felt during bone fracture.
- Inability to move the affected leg
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.
The goal of treatment in SCFE is to prevent progression or worsening of the slippage and is accomplished through surgery. Surgery is usually performed within 24-48 hours of diagnosis.
The surgical procedures available for correcting stable Slipped Capital Femoral Epiphysis include internal fixation (pinning), bone-graft epiphyseodesis or corrective osteotomy:
- Internal fixation (pinning): This surgery is performed in a hospital setting under general anesthesia. The patient may be positioned on their back during the procedure. The surgeon will make a small incision near the hip. With the use of fluoroscope (X-ray machine that captures continuous real-time images which are displayed on the TV monitor) as a guide, the surgeon will insert a metal screw or pin through the thighbone and the growth plate so that they are held in place. Your surgeon may use either a single central pin or multiple pins.
- Bone-graft epiphyseodesis: In bone graft epiphyseodesis the surgeon exposes the hip through the iliofemoral approach. A rectangular shaped piece of bone is removed from the front part of the femoral neck. A tunnel is created through the growth plate and several corticocancellous strips taken from the iliac crest bone are pushed into the tunnel across the femoral physis so that growth plate closure can be achieved.
- Corrective osteotomy: The surgeon exposes the hip by the anterior Smith-Petersen or anterolateral approach. A piece of bone is removed from the metaphysis of the femoral neck. This allows the epiphysis to be repositioned on the metaphysis without affecting epiphyseal blood supply. When the femoral neck gets shortened, the epiphysis is reduced and internally fixed with the help of 3 pins. Although, this procedure is anatomically sound, it is more invasive and may pose serious complications such as avascular necrosis and chondrolysis.
Surgical correction of unstable slipped capital femoral epiphysis can be done with internal fixation method where your surgeon makes a small incision near the hip, and under the guidance of fluoroscope may advance the screw through the metaphysis, growth plate and epiphysis such that the screw holds all three structures in place.
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Houston Hip Specialists
Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in hip treatments including arthroscopic labral repairs, minimally invasive anterior hip replacement, total and partial hip replacements.
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Thank you for the opportunity to express how pleased I am with the excellent care of Stacy A. Bacon, M.D. I have confidence in her ability to care for me as she successfully partially replaced a broken hip 10 years ago, 2007. I also want to compliment Cheryl who set up the appointment. She represents Advanced Orthopaedics & Sports Medicine very well.
It’s been over 8 years since Dr. Bacon replaced by right ankle. I still can’t thank her enough for the years of pain free walking I have done since! And I’m still going strong! I had numerous breaks in my ankle due an auto accident, repaired/set by a different doctor, after multiple surgery’s, I was still limping, in great pain every day. Then I found Dr. Bacon, now, no more pain, NONE, and no more limping after this ankle replacement. I rave about her constantly and would recommend her to anyone who has a foot or ankle issue
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I would highly recommend Dr. Cubbage if you are having any type of spinal issues. I have seen Dr. Cubbage several times over the last 3 years for lumbar pain and numbness in my left leg. Dr. Cubbage explained my diagnostic results in such a way that it was easy for me to understand. He patiently answered all my questions and explained my options. Fortunately, Dr. Cubbage has been able to manage my pain with conservative treatment but know surgery is inevitable. When that time comes, I would choose no other than Dr. Cubbage! And it’s a plus that he has such a kind and caring staff.
For the first time in many years and many knee operations on one leg I am without any knee pain. This is a result of a procedure performed by Dr. Patel.
I made an appointment to see Dr. Patel on the recommendation of Dr. Tanous following knee replacement and several months of continued pain. Dr. Patel explained the procedure to me and explained how we would proceed. The first procedure was to determine if I would be a good candidate for the second procedure. After the first procedure my pain was anywhere from 0 and 5. Dr. Patel explained to me at follow-up that I was not a good candidate for the second procedure due to my pain level being above the 0 to 3 level. After talking for a while I said “any relief would be better than the pain I had been having.” With this it was agreed that I would have the second procedure. It has now been 6 days since the procedure and I am without any pain.
I realize this is only a few days of not being able to sleep, with a pillow between my knee or under my leg at night. I know the pain may come back at anytime but until then it has been well worthwhile. I hope it will last 6 months, if not, I will have the procedure again after 6 months.
Thank you Drs. Patel and Tanous.
Outstanding Physicians. I’ve had two surgeries here, one on my foot with Dr. Bacon, and an extensive back surgery with Dr. Cubbage. I’m new to the area and my wife found me these surgeons. I have to say that each surgery I’ve had with these physicians have had excellent results. I was very pleased with my foot surgery and decided to see Dr. Cubbage for my back. Other surgeons I’ve seen regarding my back only gave me a 50/50 success rate. I have to say, the low back surgery with Dr. Cubbage was like a miracle. Right away, I noticed a difference and I’ve continued to improve rapidly. I’m almost eight weeks out and I haven’t felt this good in years. I’d like to thank Dr. Stacy Bacon for my foot surgery and Dr. Matthew Cubbage for my low back surgery. Without these drastic results, I’d not be walking today. Thank you all very much and I highly recommend your services. God bless you all.
Dr. David R. Mack replaced my right hip in June 2009, and my left in October 2010. I am already able to go places and do things on my own again. His excellent staff are very caring and helpful throughout the entire process, including recovery. The out-patient therapy is the best. I am walking very well now and am very pleased to have my life back. Thank you so much Dr. Mack and your great staff! Sincerely,
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When I started, I couldn’t put any weight on my right leg and now I can do virtually anything. While I hope to not need future therapy, this is without a doubt the place I will return to in the future.