Slipped capital femoral epiphysis

Overview

Slipped capital femoral epiphysis, or SCFE, is a hip problem in which the growing end (epiphysis) of a child's thighbone (femur) slips from the top of the bone. SCFE can occur in just one hip or both. It most frequently affects children between the ages of 9 and 15 during growth spurts. It's more common in boys, African Americans and Pacific Islanders.

SCFE has no known cause. It can occur after an accident, such as a fall, or develop gradually. Risk factors include:

• Obesity
• Rapid growth
• Hormonal changes of puberty
• Hypothyroidism (underactive thyroid gland)

Signs & symptoms

Kids with SCFE may experience:

• Pain in the knee, hip, thigh or groin
• Decreased or painful hip motion
• Limping and difficulty walking
• An outward turn to the affected leg while standing

Diagnosis

To diagnose SCFE, your child's care provider will take X-rays of the pelvis and thigh area.

Treatment

SCFE is treated with surgery to prevent the femoral head (the ball-like end of the femur) from slipping further. If diagnosed with SCFE, your child should immediately stop putting weight on the leg to prevent additional damage. This means being on bed rest until surgery.

In this procedure, an orthopedic surgeon makes a small incision at the top of the thigh and, in most cases, inserts a screw to hold the femoral head in place. The incision is then closed and covered with a dressing.

Your child's surgeon will go over all risks of the procedure with you beforehand. They include bleeding and infection. Some children continue to have limited range of motion and an abnormal gait after the surgery.

Post-op care

Your child will need to stay in the hospital for one to two days after SCFE surgery. We will give your child pain medicine as needed.

For a period directed by the doctor (usually about six weeks), your child should not put weight on the affected leg. A physical therapist will teach your child how to use crutches or a walker.

Call the orthopedic clinic where your child was treated if you have concerns after returning home. In particular, call if you notice any of the following:

• Fever above 101.5 F
• Pain that isn't relieved by medication
• Drainage from the incision
• Signs of infection, such as redness, swelling, fever, and pus or foul-smelling odor at the incision
• Change in sensation in the leg, such as numbness, tingling or skin that is cool to the touch
• Pain in the opposite hip, if surgery wasn't performed on both legs

If your child was treated at our Oakland campus and an issue arises outside of regular clinic hours, please call the hospital operator at (510) 428-3000 and ask for the on-call orthopedic resident to be paged.

Your child will return to our clinic one week after surgery for a checkup and an X-ray. At this point, we'll remove the dressing from the incision.

Return to activities

After the follow-up appointment, your child may start taking showers again. However, the incision should not be submerged in water until it's completely healed.

Your child may return to school, using crutches, three to five days after surgery. Check with your child's school to see whether they can provide assistance, such as access to an elevator or an assigned buddy. If the school can't accommodate your child, we can send a request for home instruction.

Your child may not participate in gym class or contact sports for at least a few months, and possibly for several years, until the thighbone stops growing. Your child's surgeon will determine when it's safe to return to these activities.