Slipped Capital Femoral Epiphysis (SCFE)
The hip joint is between the femoral head (ball) and the acetabular socket in the pelvis (cup). Slipped Capital Femoral Epiphysis is the most common hip disorder in older children and adolescents. The ball slips through its growth cartilage and settles at an angle to the neck and the shaft.
Who Is Affected?
Majority of slips happen in obese children without any other abnormality. A few patients may have hormonal disorders, renal disease, rickets, etc.
Symptoms
Pain and limp are the most common complaints. The pain may be mild and felt in the hip, thigh, or the knee leading to delayed diagnosis. Children may continue to be active with some pain suggesting that the slip is stable.
Sudden exacerbation of the pain along with inability to walk even with crutches suggests an unstable slip, which has higher complications and poorer results.
Diagnosis
The diagnosis is usually suggested by the clinical exam and confirmed by plain x-rays. Both stable and unstable slips change the shape of the femoral head and limit hip motion in certain directions. The more severe slips are well known to lead to arthritis.
Treatment Goal
The goals of treating a slipped hip are to stabilize the slip from getting worse and avoid complications in the short term and avoid joint damage in the long term. Once diagnosed, the child is placed on rest and crutches, and surgery is recommended.
In-situ Screw Fixation
A simple, quick procedure that involves a small incision and fixation of the femoral head in its place with a screw. This works well to freeze the head with the present deformity and has very few complications. The persistent deformity can cause damage to the joint.
Reshaping of the Head and Neck
The deformity caused by the slip acts as a bump and jams against the cup and its labrum causing damage. This bump can be removed through arthroscopic or limited open technique but is adequate by itself only in mild slips.
Severe Slips — Osteotomy
In severe slips, in addition to the shaving of the bump, the ball has to be reoriented on the thighbone by separating the ball from the shaft — called osteotomy. We have vast experience with performing the femoral neck osteotomy through surgical dislocation.
Safe surgical dislocation of the hip joint while preserving the blood supply to the ball enables procedures that were once considered unsafe. The femoral head is separated from the neck completely at the area of the deformity, the neck is reshaped, and the ball is replaced on to the neck correcting the deformity completely.
Patient Forms
SCFE Consent Form (PDF)