Slipped capital femoral epiphysis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Slipped capital femoral epiphysis
X-ray of a slipped capital femoral epiphysis
Synonyms	SCFE, slipped upper femoral epiphysis (SUFE)
Pronounce
Specialty	Orthopedic surgery
Symptoms	Hip pain, knee pain, limping
Complications	N/A
Onset	Adolescence
Duration
Types	Stable, Unstable
Causes	Obesity, hormonal changes
Risks	Obesity, endocrine disorders, growth spurts
Diagnosis	X-ray, physical examination
Differential diagnosis	Hip dysplasia, Legg-Calvé-Perthes disease
Prevention
Treatment	Surgery, physical therapy
Medication	Pain management
Prognosis	Good with treatment
Frequency	1-10 per 100,000 children per year
Deaths	Rare

Slipped Capital Femoral Epiphysis (SCFE) is a medical condition affecting the hip joint, where the femoral head slips off the neck of the femur at the growth plate. This condition is most commonly seen in adolescents and can lead to significant hip pain and dysfunction if not treated promptly.

Pathophysiology

SCFE occurs when the growth plate (physis) of the femoral head weakens, allowing the head to slip in relation to the femoral neck. This slippage is typically posterior and inferior. The exact cause of the weakening is not fully understood, but it is believed to be related to hormonal changes during puberty, mechanical stress, and possibly genetic factors.

Epidemiology

SCFE is most commonly seen in adolescents between the ages of 10 and 16 years. It is more prevalent in males than females and is often associated with obesity. The condition is bilateral in approximately 20-40% of cases.

Clinical Presentation

Patients with SCFE typically present with hip or knee pain, a limp, and limited range of motion in the affected hip. The pain may be referred to the knee, which can sometimes lead to a delay in diagnosis. On physical examination, there is often limited internal rotation of the hip.

Diagnosis

X-ray showing a slipped capital femoral epiphysis

The diagnosis of SCFE is primarily made through radiography. Anteroposterior and frog-leg lateral views of the pelvis are typically obtained. The classic radiographic finding is the displacement of the femoral head relative to the femoral neck. The "Klein's line" test can be used to assess for slippage.

Treatment

The primary treatment for SCFE is surgical stabilization of the femoral head to prevent further slippage. This is typically achieved through in situ pinning, where a single screw is placed across the growth plate. In severe cases, more complex surgical procedures may be required.

Prognosis

The prognosis for SCFE depends on the severity of the slip and the timeliness of treatment. Early diagnosis and treatment are crucial to prevent complications such as avascular necrosis of the femoral head and osteoarthritis.

Complications

Potential complications of SCFE include avascular necrosis, chondrolysis, and early onset osteoarthritis. These complications can lead to long-term disability and may require further surgical intervention.

See also

• Femur
• Hip joint
• Growth plate
• Avascular necrosis