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Slipped Capital Femoral Epiphysis (SCFE)

    • What is slipped capital femoral epiphysis (SCFE)?

      slipped capital femoral epiphysis

      Slipped capital femoral epiphysis (SCFE) is a condition affecting the hip joint in pre-teenagers and teenagers who are still growing. In SCFE, the neck of the thigh bone (femur) slips out of position at the level of the growth plate, in relation to the head. The growth plate, which is made up of cartilage, is a point of weakness. The resulting slippage affects the alignment of the bone, and hence the joint.

      SCFE develops gradually over time, usually during the onset of puberty when there is a period of rapid growth. It can sometimes be confused with a fracture through the same growth plate, but in that instance, there would usually be a history of a fall or trauma.

      SCFE is the most common hip disorder in pre-teens and teenagers, usually between the ages of 10 and 16. Patient may complain of pain in one hip with resultant difficulty in bearing weight on the lower limb of the affected side. However, younger patient may experience the same problem in the opposite hip within 18 months. It is also more common in boys than girls and can lead to complications in the hip joint if left untreated.

      There is a classification which enables the doctor to tell how urgent management needs to be done:

      • Stable SCFE

        Patients with stable SCFE are able to walk or bear weight on the affected hip. They may limp from time to time, especially after they have been active. This normally subsides with rest. Most cases of SCFE are stable SCFE.

      • Unstable SCFE

        Patients with unstable SCFE may have a more severe slippage of the joint, hence they are unable to walk or bear any weight on the affected hip. Unstable SCFE requires urgent treatment, as they are more prone to complications.

    • Experts are unsure what causes SCFE, though there are several known risk factors. It is more likely to occur during the growth spurt of puberty; more likely to affect the left hip, and are more common in boys than in girls.

      Other risk factors include:

      • Excessive weight or obesity
      • Family history of SCFE
      • Down Syndrome
      • Certain disorders of the metabolic or endocrine system such as hyperthyroidism, hypothyroidism, hypopituitarism, or growth hormone deficiency
      • Kidney (renal) disorders due to their effect on calcium, which can affect bone strength and development
    • Symptoms of SCFE vary widely, depending on its severity.

      Stable SCFE

      Patients with stable SCFE typically experience milder symptoms of pain or stiffness in the groin, hip, knee or thigh. The pain is likely to come and go for several weeks or months. It may get worse with activity, but the patient is still able to bear weight on the affected side.

      Unstable SCFE

      In severe or unstable SCFE, patients usually experience pain, which can start suddenly, especially after a fall or injury to the hip. Under these circumstances, patients are unable to walk or place any weight on the affected side. There may also be visible signs such as a discrepancy in leg length or an outward turning (external rotation) of the affected leg.

    • Early diagnosis of SCFE is important to help prevent pain and potential complications.

      In order to diagnose SCFE, the doctor will need to review the patient’s health and medical history, and conduct a physical examination to look for:

      • Pain when the affected leg is rotated
      • Limited range of hip motion
      • Muscle spasms
      • Limping
      • Abnormal gait or way of walking

      Imaging scans such as magnetic resonance imaging (MRI) or X-rays of the pelvic, hip and thigh bones will also help the doctor to confirm the diagnosis.

    • Early diagnosis and treatment offer the best chance for successful treatment.

      Treatment for SCFE aims to stabilise the hip and prevent the head of the thigh bone from slipping any further. This is normally accomplished through surgery, which is often performed shortly after diagnosis. While waiting for surgery, the patient should reduce the use of their legs as much as possible.

      The type and severity of the patient’s SCFE will determine the appropriate surgical procedure, which includes the following:

      In-situ fixation

      A small incision near the hip allows the doctor to insert a metal screw through the femur and across the growth plate. This helps to keep the rounded head of the thigh bone (femur) in position as well as fuse or close the growth plate, preventing further slippage.

      Open reduction

      An open reduction is performed on patients with more severe cases of deformity. An incision is made in the hip, allowing the doctor to move the head of the thigh bone into its correct position. To hold it in place, metal screws are inserted to keep the bone in place until the growth plate closes. Compared to an in-situ fixation, open reduction is more extensive and requires a longer recovery time.

      In-situ fixation in the opposite hip

      Some patients face a higher risk of developing SCFE in the other hip. In such instances, the doctor may recommend an in-situ fixation on the unaffected hip as well.

      Recovery time will vary according to the severity of the condition and the type of procedure that was performed.

      Post-surgery, patients should expect to use crutches or a wheelchair for 6 weeks or more. Physiotherapy will also be recommended to help strengthen the leg and hip muscles and improve range of movement.

      Follow-up visits, which may include X-rays, are important to help monitor the healing process, detect possible complications and allow discussions on when normal activities such as sports may be resumed.

    • The most common complications of SCFE are avascular necrosis and chondrolysis.

      Avascular necrosis

      Avascular necrosis is more likely to occur in severe or unstable SCFE, in which blood flow to the head of the thigh bone (femur) is restricted. Also known as osteonecrosis, this limited blood supply causes the bone and cartilage to collapse, allowing bone to rub against bone, resulting in severe pain. Treatment includes surgery to reconstruct the hip.

      Chondrolysis

      Chondrolysis is a rare but serious complication where the cartilage on the surface of the hip joint breaks down. The resulting pain and deformity can lead to loss of motion in the hip. Chondrolysis is treated using anti-inflammatory medication and aggressive physiotherapy to help patients regain limited motion in the affected hip.

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