Slipped Capital Femoral Epiphysis or SCFE is a hip condition that mostly occurs in teenagers. The hip is a ball and socket joint in which the head of the thigh bone fits into the socket of the large pelvic bone called acetabulum. The thigh bone grows along two growth plates (physis) that are found at each end of the femur. The growth head located at the upper end of the femur solidifies to become the femoral head and is also referred to as the epiphysis. In case of SCFE, this epiphysis gets displaced as the head of the thigh bone slips backwards. The condition may take some time to develop and is more prevalent in teenage boys. Timely diagnosis and appropriate treatment is necessary to prevent future complications like Hip Arthritis.
SCFE can be classified as follows:
- Stable SCFE – The joint feels slightly unstable and the patient may be able to move around with some help
- Unstable SCFE – The patient is unable to bear body weight even if walking aids such as a walker or crutches are used. This condition may also become a potential cause of Avascular Necrosis in the hip bone.
Causes
- A sudden fall
- Major trauma caused to the hip or pelvis joint
- Hereditary factors
- Being obese or over weight
- Metabolic disorders such as hyperthyroidism
- In some cases, a person may develop SCFE over a period of time even with no previous record of physical injury
Symptoms
- Pain may be felt in the hip, groin, knee or thigh post injury
- Stiffness
- Unstable joint
- Inability to bear body weight
- In most cases, only one side of the hip joint is affected. However, in patients below the age of 10 years, the chances of both sides being affected are higher
- The affected leg may appear shorter and turned outwards compared to the normal one
- Change in gait
- Physical activity may exaggerate the symptoms
Diagnosis
- Medical history, family traits and symptoms may be taken into account
- Detailed clinical evaluation may be required to check range of motion in the affected leg
- The patient’s gait may be observed
- X-ray imaging may be conducted to analyze bone structure and locate the femoral head
Treatment
The femoral head or epiphysis is stabilized through a surgical procedure in all cases. It may be carried out as follows:
- In case of stable SCFE, in situ fixation is carried out by fixing the femoral head using a metal screw. As the growth plate grows and the screw gets fused within it
- In case of unstable SCFE, a large incision is made in the hip joint and the displaced bone head is brought back to the correct anatomical position. It is held in place using two screws which eventually fuse within the joint
- In cases where in the patient is likely to develop SCFE in the opposite hip as well, in situ fixation may be preformed to eliminate the risk
- Physical therapy may be recommended post surgery
- The patient may be advised to use crutches for a few weeks to allow the joint to heal
- Regular follow ups and some repeat X-rays may be required to monitor the joint condition for 1-2 years after surgery
