Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE or “skiffy”) is a hip condition that occurs in growing pre-teens and teens where the ball of the thigh bone (femoral head) slips off the neck of the bone in a backwards direction. This condition usually develops overtime and is more common in boys than girls.

General Facts

• SCFE is the most common hip disorder in adolescents.
• Usually occurs during growth spurts, shortly after the onset of puberty
• Usually only one hip is affected
• Up to 40% (particularly younger than age 10) will develop SCFE on the opposite side as well- usually within 18 months.

Types of SCFE

1. Stable SCFE:
   • Patient is able to walk or bear weight on the affected hip
   • Most common
2. Unstable SCFE:
   • More severe
   • Patient is unable to weight bear, even with crutches.
   • Requires urgent treatment
   • More commonly lead to complications   

Symptoms

1. Mild or Stable:
   • Intermittent pain in the groin, hip, knee and/or thigh for several weeks or months
   • Pain worsens with activity
   • Limping after activity
   • Stiffness
   • Limited range of motion- specifically internal rotation
2. Severe or Unstable:
   • Sudden onset of pain (after a fall or trauma)
   • Inability to walk or bear weight on affected side
   • Outward turning (external rotation) of the affected leg
   • Discrepancy in leg length (affected leg may appear shorter than unaffected leg)

Causes

1. Specific cause is unknown
2. May occur after a minor fall or trauma
3. May develop gradually with no previous injury

Risk Factors

1. More common in boys than girls.
2. Most common in boys between the ages of 12 and 16
3. Girls between the ages of 10 and 14
4. Excessive weight or obesity
5. Family history of SCFE
6. Endocrine or metabolic disorder (ex. Hyperthyroidism)

Diagnosis:

1. Early detection is key- provides best chance of stabilizing the hip and avoiding further complications
2. Detailed history and physical examination
3. X-rays- positive x-ray will show the head of the femur appearing to slip off the femoral neck.

Treatment

SCFE is treated through surgical methods

• In situ fixation
• Open reduction
• In situ fixation in the opposite hip