Slipped capital femoral epiphysis
Slipping of the head of the femur / epiphysiolysis

Slipped capital femoral epiphysis (SCFE) is a hip problem that occurs when the head of the femur (thigh bone) threatens to separate from the femur. The condition affects children age 8 to 17. It can occur in one leg, but can also affect both legs. The condition is unusual and diagnosis is often missed in children.

The abnormality is more common in children who are obese. However, very tall, skinny children also belong to the at-risk group.

Description of condition

Slipped capital femoral epiphysis frequently occurs during a growth spurt, shortly after starting puberty. For reasons that remain unclear, the growth plate located between the head of the femur and the femur weakens. This causes the femur to shift upward and forward compared to the head of the femur. This may occur as an acute condition or a chronic condition.

Cause and history

The acute form usually occurs during an accident or fall and is very painful. The chronic form is associated with milder symptoms and these symptoms develop gradually. Consequently, the symptoms are often incorrectly interpreted as the result of a chronic sporting injury.

Signs & symptoms

The patient usually limps and this is sometimes accompanied by pain in the hip, groin, thigh or knee that is hard to locate. In some severe cases, the child is no longer able to bear weight on the affected leg. There is a discrepancy in leg length, with the affected leg being slightly shorter than the other. The foot is often rotated outward slightly, because the hip has rotated outward.

Diagnosis

The diagnosis is made using X-rays.

Treatment

The head of the femur is fixed surgically to the femur to prevent further slipping of the head of the femur until the growth plate has fused and ossified.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Nugteren, K. van & Winkel, D. (2007). Onderzoek en behandeling van de heup. Houten: Bohn Stafleu van Loghum.
Peck, D. (2010). Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician. 2010 Aug 1;82(3):258-62.
Verhaar, J.A.N. & Linden, A.J. van der (2005). Orthopedie. Houten: Bohn Stafleu van Loghum.