Dr. MJ Bazos MD,
Femoral Epiphysis (SCFE)
What is slipped capital femoral
Slipped capital femoral epiphysis (or SCFE, for
short) is a hip problem that starts if part of the growing end (the epiphysis)
of the thigh bone (the femur) slips off from the top of the thigh bone. SCFE may
develop in one leg or it may occur in both legs.
Who can get SCFE?
SCFE usually occurs in children between 11 and
16 years of age. SCFE often occurs in children who are overweight. More boys
than girls get SCFE, and it's more common in blacks than in whites. The cause of
SCFE usually isn't known. SCFE is typically divided into 2 types: stable and
What's the difference between stable
and unstable SCFE?
A child is considered to have "stable" SCFE if
he or she can walk with or without crutches. More than 90% of cases are stable.
A child who can't walk, even with crutches, has
"unstable" SCFE. Unstable SCFE often occurs after a trauma, such as a sports
injury or a fall. Falling can also turn a stable SCFE into an unstable one.
What are the symptoms of stable
A child with stable SCFE may first have
stiffness in the hip, which may get better after rest. After a while, the
stiffness may turn into a limp, and the child may have pain that comes and goes.
The pain is often felt in the groin, the thigh or the knee, and not necessarily
in the hip itself.
In the later stages, the child may lose some
ability to move the involved hip. This leg will usually twist out. It may look
shorter than the other leg. He or she may not be able to play sports or do
simple tasks like bending over to tie his or her shoes. The symptoms may change
gradually or rapidly.
What are the symptoms of unstable
A child with unstable SCFE has extreme pain. The
pain is similar to what might be felt with a broken bone. The child probably
won't be able to move the injured leg. If you think your child has unstable
SCFE, don't force the leg to move. That could make the thigh bone slip even
How is SCFE diagnosed?
To check for stable or unstable SCFE, your
doctor will take x-rays that show the pelvis and thigh area from several
different angles. Your doctor will then decide which tests are needed and
explain each test to you.
How is SCFE treated?
Once SCFE is diagnosed, your doctor will
probably refer your child to an orthopedic surgeon (a doctor who fixes bone
problems). Surgery is usually the treatment of choice. It's important to get
treatment right away.
The most common treatment of SCFE is called
"in-situ fixation." With this treatment, the bone is held in place with a single
central screw. This screw keeps the thigh bone from slipping and will close the
growth plate. The results of this treatment are very good. It has few
Other surgical treatments (including in-situ
fixation with more than one screw) are used less often. Ask your doctor to
explain the potential benefits and risks of the treatment options.
What are the complications of SCFE?
The most serious complications of SCFE are
avascular necrosis (a lack of blood flow to the bone) and chondrolysis (decay of
cartilage). Avascular necrosis is more common in patients with an unstable SCFE.
The risk of these complications increases as the
severity of SCFE increases. This is why it is important to get treatment right
When can my child get back to normal
Getting better takes time. For 4 to 6 weeks
after surgery, your child will need to use crutches to walk. Then your child can
slowly get back into normal activities, including running and contact
Will my child recover completely?
If SCFE is caught early, there is a very good
chance for full recovery, especially if SCFE is stable. However, some children
who have had SCFE may get arthritis in the hip later in life.