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Slipped Capital Femoral Epiphysis (SCFE)

What is slipped capital femoral epiphysis (SCFE)?

To understand SCFE (pronounced “skiffy”), it helps to know a little about what the hip joint looks like.

The top part of the thighbone is shaped like a ball (femoral head). It fits into the hip socket. The ball is connected to the straight part of the thighbone by the growth plate, an area of tissue that in children is still developing.

In SCFE, the top or cap of the ball slips off the femoral head through the growth plate. Think of the ball as being like a scoop of ice cream that falls off its “cone,” the thighbone.

Almost all children with the condition have surgical treatment, and most do well. Some, however, develop problems due to the disease.

One foot might point outward more than the other, or one leg may be slightly longer than the other. Blood may stop flowing to the top part of the thighbone. Children’s hips may be stiff, and they may be more likely to develop arthritis at an early age.

Other children with more severe slips have more problems after surgery.

How do you evaluate SCFE?

Grading severity of SCFE.
Grading severity of SCFE.

Some children with SCFE come to us after they start to limp or feel some mild pain in their hips or groin or around their knees. Other children suddenly feel severe pain that stops them from putting weight on the leg that hurts.

In both cases, children may not have had any injury before the pain starts.

When your child comes to the clinic, we will examine him. We will look for any problems your child has moving his legs and hips, including having pain and less motion than is usual.

We will take X-rays. If the X-rays look normal, we may ask your child to have an MRI of his hip.

If your child does have SCFE, we will ask him to stop putting weight on the leg that is affected, even if it does not hurt. This will help lower the chance of more slipping. In most cases, we will admit your child to the hospital for surgical treatment.

Who gets SCFE?

Both boys and girls get SCFE. They are almost always adolescents — approaching their teenage years or just into them.

Overweight children are more likely to have the problem, as are children with a family history of SCFE.

Children who have diseases of the endocrine system, which produces hormones, also have a greater chance of having SCFE. Diabetes and Cushing syndrome are examples of endocrine system diseases.

Children with kidney failure, thyroid problems or growth hormone abnormalities are also at risk of developing SCFE.

What is your experience with SCFE?

Children’s Hospital has orthopedic surgeons who have extensive experience in identifying, treating and managing SCFE.

Our doctors are experts in stabilizing the bone so the ball does not slip any more. They are also leaders in more complicated operations to reposition bones.

How do you treat SCFE?

Slipped capital femoral epiphysis.
Slipped capital femoral epiphysis.

SCFE is a problem that needs urgent attention. If your child has SCFE, he will need surgery so that the ball does not slip off the bone any farther.

During this operation, the doctor will probably reposition the hip slip and make a small incision near your child’s hip. He will put a metal screw through the bone and the growth plate in the cap of the femoral head to stabilize the bone.

Often, children can leave the hospital on the same day as the surgery, or on the day after.

The goal of the initial treatment is to stabilize the ball and prevent it from moving any more. We do not try to put the bone back in place because that may create a problem with the blood flow to the ball of the hip joint.

If the ball position causes problems after your child has healed following surgery, he may need surgery to reposition the ball to improve motion and function.