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.
To request an appointment, please enter the information on the form on the right and press the “Continue” button to start the appointment request process.
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.
Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment piriformis syndrome, greater trochanter bursitis, ischial bursitis, sacroiliac joint pain and hamstring tendonitis/tears. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.
Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Shoulder Treatment Services.
1Professional Building II At North Cypress Medical Center
2North Cypress Professional Building At Lakewood Crossing
3North Cypress Professional Building At Towne Lake
4Advanced Orthopaedics Memorial
What Our Patients Are Saying
Each procedure done by Dr. Patel has been an improvement. Very pleased.
Dr. Patel has been a great Doctor for me. When I was referred to after discussion we decided to do injections in my back. The first two did not work so did two more in a different section of my back. These injections worked great. I’m now able to sleep at night and the numbness in my foot is almost gone. The tingling in my foot & leg is gone and I am very happy about that. I am extremely happy that Dr. Patel is my Doctor. She has been a good listener when I tell her where I hurt and talks to me about what she feels should be done. The final decision is always mine.
On Nov. 22, 2017, I had a spinal injection in my lower back and it was an instant miracle in my life! For the first time in 4 intolerable months of pain, I was finally pain free, and I am now getting a second chance to live again! I am so grateful to Dr. Patel for my new life, and to God for guiding me to her! Thank you so very much Dr. Patel – you are God’s gift to me, thank you for being so awesome at what you do.
Dr. Patel is one of the best Doctors I have ever had. She is pretty good at her job. She makes it plain and simple. She is also very thoughtful. I was very glad to have met her. In other words she is pretty good.
The surgery done by Dr. S. Patel (Actually injections) & the mild medications she has prescribed has surely made my lower back -hip-leg less painful. I have complete confidence in her medical judgement & advice. She will administer second injection in June.
Dr. Patel is a very good Pain Management Doctor. She is one of my favorite doctors.
Dr. Patel has been great at my pain relief. She doesn’t force me to take any meds I don’t want, or injections. She will give me the injection I want when I need it. Great friendly Doctor.
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
I had been in so much pain with my back for years. It got so bad that I knew I had to do something. I went to Dr Mohr for help. I was so afraid to have spine surgery as I had heard so many horror stories. He and his staff were very informative. I was amazed at the new technology in spinal surgery. December 8, 2016 I had rods and pins put in my back. I am so happy I did now. I am healing really fast and the pain is going away as my body heals. Thank you Dr Mohr for you expertise and sensitive nature. You were understanding about my fear and helped assure me so I could receive the help I needed. You are an excellent Doctor.