Slipped Capital Femoral Epiphysis (SCFE) is a hip condition that occurs in adolescents where the ball at the head of the femur (thigh bone) slips off in a backward direction due to weakness in the growth plate (physis). It is a serious condition that requires prompt medical attention to prevent long-term complications.

Common Symptoms

• Hip Pain: Persistent or intermittent pain in the hip, groin, thigh, or knee.
• Limping: Noticeable limp or change in gait.
• Stiffness: Limited range of motion in the hip.
• Referred Pain: Pain that can be felt in the knee or thigh.
• Leg Length Discrepancy: The affected leg may appear shorter.
• Outward Turned Leg: The affected leg may turn outward when walking or lying down.

Cause & Anatomy

• Growth Plate Weakness: SCFE occurs when the growth plate of the femoral head weakens, allowing the femoral head to slip backward.
• Hormonal Factors: Rapid growth spurts during puberty can contribute to the condition.
• Obesity: Increased body weight can put additional stress on the growth plate.
• Genetic Predisposition: Family history of SCFE can increase the risk.

The hip joint is a ball-and-socket joint where the head of the femur fits into the acetabulum of the pelvis. In SCFE, the ball (femoral head) slips off the neck of the femur due to a weakened growth plate.

Diagnosis

• Evaluation of symptoms, medical history, and physical examination of the hip.
• X-rays: The primary diagnostic tool showing the slip of the femoral head.
• MRI or CT Scan: May be used for detailed imaging if the X-rays are inconclusive or to assess the extent of the slip.

Prevention

• Regular Check-ups: Routine physical exams during adolescence to monitor growth and development.
• Weight Management: Maintaining a healthy weight to reduce stress on the growth plate.
• Awareness: Early recognition of symptoms and seeking prompt medical attention can prevent worsening of the condition.

Non-Surgical Treatment

Non-weight Bearing: Advising the patient to avoid putting weight on the affected hip to prevent further slipping.

Surgical Treatments

• In Situ Fixation: The most common procedure where a single screw is inserted to hold the femoral head in place and prevent further slipping.
• Open Reduction: In severe cases, the femoral head may need to be realigned before fixation.
• Bone Grafting: Occasionally used to support the stability of the hip.

Rehabilitation

Post-Surgical Care:

• Non-weight Bearing: Initially, the patient will need to avoid weight-bearing activities.
• Gradual Weight-Bearing: Gradual reintroduction of weight-bearing activities as healing progresses.
• Physical Therapy: To restore strength, range of motion, and normal gait.

Long-Term Monitoring:

• Regular follow-up visits to monitor healing and hip function.
• Monitoring for potential complications such as avascular necrosis (loss of blood supply to the femoral head) or chondrolysis (loss of cartilage).

FAQ’s

What age group is most commonly affected by SCFE?
SCFE typically occurs in adolescents between the ages of 10 and 16, during periods of rapid growth.

Is SCFE more common in boys or girls?
SCFE is more common in boys than girls.

Can SCFE occur in both hips?
Yes, SCFE can be bilateral, affecting both hips either simultaneously or sequentially.

What are the long-term outcomes of SCFE?
With prompt treatment, many patients can return to normal activities. However, long-term outcomes depend on the severity of the slip and the timeliness of treatment.

Can SCFE recur after treatment?
Recurrence in the treated hip is rare, but the other hip may develop SCFE, so regular monitoring is important.

How soon can an adolescent return to sports after SCFE surgery?
Return to sports and other activities will depend on the individual’s recovery and the surgeon’s advice, typically several months post-surgery.

Are there any complications associated with SCFE surgery?
Potential complications include infection, avascular necrosis, chondrolysis, and hardware problems. Regular follow-up is essential to address any issues promptly.

What are the signs of complications after SCFE surgery?
Signs include persistent pain, swelling, limited range of motion, and changes in gait. Any concerns should be promptly discussed with the healthcare provider.

How is the severity of SCFE determined?
Severity is assessed based on the degree of slip, with classifications as mild, moderate, or severe.

What is the prognosis for SCFE if left untreated?
Untreated SCFE can lead to severe hip deformity, chronic pain, limited mobility, and early-onset arthritis.