Slipped capital femoral epiphysis (SCFE)

What is slipped capital femoral epiphysis (SCFE)?

Slipped capital femoral epiphysis (SCFE) is a condition in which the growing end (called the epiphysis) of the thighbone slips away from the top of the bone. This can occur in just one hip or both. SCFE mainly affects children between the ages of 9 and 15 during growth spurts, and is more common among boys, African Americans and Pacific Islanders.

SCFE can be treated with a surgical procedure to stabilize the bone.

Causes of SCFE

Experts don't know what causes slipped capital femoral epiphysis. It can happen after an accident, such as a fall, or it can develop gradually. Risk factors include:

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

Symptoms of SCFE

Children with slipped capital femoral epiphysis may have:

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

Diagnosis of SCFE

To diagnose slipped capital femoral epiphysis, your child's doctor will:

• Examine the affected leg and hip
• Observe your child's gait (the way they walk)
• Order X-rays of the pelvis and thigh area

Treatment for SCFE

Slipped capital femoral epiphysis is treated with surgery to prevent the femoral head (the ball at the top of the thighbone) from slipping further. If your child has been diagnosed with SCFE, they should immediately stop putting weight on the leg to prevent additional damage. This means they will need to be on bed rest until surgery.

In this procedure, an orthopedic surgeon makes a small incision at the top of the thigh and inserts a screw through the femoral head to hold it 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, including the possibilities of bleeding and infection. Some children continue to have limited range of motion and an abnormal gait after the surgery.

Recovery from SCFE surgery

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

After the surgery, your child should avoid putting weight on the affected leg for a period of time (typically six weeks, but please follow the doctor's exact instructions). A physical therapist will teach your child how to use crutches or a walker.

If you have concerns after your child returns home from the hospital, call the orthopedic clinic where they were treated. If they were treated at our Oakland campus and there is an issue outside of regular clinic hours, call the hospital operator at (510) 428-3000 and ask the operator to page the on-call orthopedic resident.

Be sure to 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 a 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)

Your child will return to our clinic one week after surgery for a checkup and an X-ray. During this visit, we will remove the dressing covering the incision.

Returning 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. Please 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 make these accommodations, 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. The surgeon will determine when it's safe to return to these activities.