Slipped Capital Femoral Epiphysis

SCFE can be classified into two main types:

• Stable SCFE: The child is still able to walk, though often with a limp.
• Unstable SCFE: The child cannot walk or put weight on the affected leg.

The signs and symptoms differ depending on the type of SCFE.

• Stable SCFE is associated with:
  • Difficulty in walking (the patient walks with toes pointing outwards).
  • Intermittent pain in the hip/groin or even in the knee of the affected side, which especially increases after walking/exertion.
• Unstable SCFE is a more severe form of disease in which there is:
  • Sudden onset of pain after an episode of a recent fall.
  • The child cannot walk without support.
  • The leg is externally (outwards) rotated.
  • There is a limb length discrepancy (the affected leg is shorter than the unaffected leg).
  • Both hips might also be affected at different stages.

If not treated properly, SCFE can lead to the following complications:

• Avascular necrosis, where the blood supply to the femoral head decreases, causing bone damage.
• Chondrolysis, a rare but serious complication where the femoral head breaks down.
• Impingement, where abnormal positioning of the femoral head limits hip movement.

No single cause of SCFE exists; however, certain factors make children more likely to develop this condition:

• Obesity and male sex as the more common in overweight male teenagers.
• Hormonal disorders such as thyroid disease or kidney problems.
• Use of steroid medicines, which can weaken bone and growth plate health.

Doctors use both examination and imaging to confirm SCFE:

• Physical examination may show pain around the hip and reduced ability to turn the leg inwards.
• X-rays are usually taken from two angles and usually provide a clear diagnosis.
• Magnetic resonance imaging (MRI) may be helpful when X-rays cannot diagnose the disease, especially in the early stages of SCFE.

Depending on the severity of SCFE and the child’s general condition, doctors may recommend one or more of the following approaches to treat SCFE:

• Non-surgical treatment is used in the initial phase of the disease. This comprises:
  • Rest and strictly non-weight bearing on the affected side.
  • Management of obesity if present.
  • In fewer cases, the application of a hip spica cast (plaster) to immobilise the hip joint.
• Surgical treatment is required in most cases and is performed under general or spinal anaesthesia based on the general condition of the patients and their preferences.
  • In-situ fixation, where 1–2 screws are inserted to hold the femoral head in place and prevent further slipping. Preventive surgery may sometimes be done on the opposite hip.
  • Open reduction, which is used in severe or unstable cases when closed reduction and screw fixation are not possible.
• After surgery, the children usually start walking with support after a couple of weeks. Most can return to sports after 4–6 months, depending on the recovery.

Medical attention should be sought promptly if:

• A child suddenly develops hip, groin, or knee pain, especially after a fall.
• Walking becomes difficult or impossible.
• The leg looks turned outward or shorter than the other.
• Symptoms do not improve with rest and continue to worsen.

While SCFE cannot always be prevented, specific steps can be taken to reduce the risk:

• Maintain a healthy body weight during childhood and adolescence.
• Seek medical evaluation for children with hormonal or kidney problems.
• Ensure regular follow-up with a doctor if the child is on long-term steroid medicines.

Patients with SCFE are advised to consult with:

• A general physician or paediatrician for initial assessment and referral.
• An orthopaedic surgeon, especially a paediatric orthopaedic specialist, for diagnosis and surgical treatment.
• A physiotherapist for rehabilitation and safe return to daily activities and sports.