by Ronisha Johnson

Created on: June 15, 2009

Slipped Capital Femoral Epiphysis, also known as SCFE, is a hip problem in pediatrics and adolescents. The problem starts if the epiphysis or growing end of the femur, the thigh bone, slips from the ball of the hip join. SCFE may develop in one or both legs.

SCFE often occurs in children that are overweight and between the ages of eleven and sixteen. It is more common in African Americans than Caucasians and affects more boys than girls. What causes SCFE is not known.

There are two types of SCFE: stable and unstable. Stable SCFE is when the affected child can still walk with or without crutches. Over ninety percent of cases are stable. Symptoms of stable SCFE include stiffness in the hip that may get better after resting. After a while the stiffness may result in a limp. The child may experience pain that comes and goes. Sometimes the pain is felt in groin, the thigh or the knee and is not always in the hip itself. In later stages of SCFE, the child may lose some ability to move the hip and the leg may twist outwards. The leg may also appear to be shorter than the other. Such symptoms may change gradually or rapidly.

Unstable SCFE is when the affected child cannot walk with or without crutches. Unstable SCFE often occurs after injury or a fall. Stable SCFE can become unstable due to a fall. Symptoms of unstable SCFE include extreme pain similar to what feels like a broken bone. The child may not be able to move the affected leg. Forcing the leg to move can cause the thigh bone to slip even more.

To check for SCFE, the pelvis and thigh area will be x-rayed from various angles. Then the doctor will determine which tests will be needed. Once diagnosed, the affected child will be referred to an orthopedic surgeon. Surgery is normally the choice treatment. Treatment is required within twenty-four to forty-eight hours of diagnoses.

Depending on the severity of the child's condition, the surgeon will recommend one of three surgical options. One option is to place a single screw into the thigh bone and the femoral epiphysis. Another is to reduce the displacement and place one or two screws into the femoral head. The third is to remove the abnormal growth plate and insert screws to aid in preventing further displacement.

The bone is not put back in place but rather the screw just prevents further slippage. Attempting to put the bone back in place may result in loss of blood flow to the bone causing it to die. If the ball position causes problems after the child has healed from the surgery, then another surgery may be needed to reposition the ball to improve motion and function.

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