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Slipped Upper Femoral Epiphysis


Slipped Capital femoral epiphysis (SCFE) is a disease of the hip where the top of the thighbone slips out of place. 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. The growth plate is 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. Almost all children with the condition have surgery. Most do well. But some develop problems later due to the condition.
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 a greater risk that the fracture will not heal

Slipped Femoral Epiphysis in Children

Both boys and girls get SCFE. They are almost always approaching their teenage years or just into them (adolescents) when the problem occurs. Several other factors can contribute to a child's chances of having the problem. SCFE is more likely to develop in:

  • Overweight children
  • Children with a family history of SCFE
  • Children who have diseases of the endocrine system which produces hormones. Diabetes and Cushing syndrome are examples of endocrine system diseases.
  • Children with kidney failure, thyroid problems or growth hormone abnormalities

Risk factors

  • Mechanical: local trauma, obesity.
  • Inflammatory conditions: neglected septic arthritis.
  • Hypothyroidism, hypopituitarism, growth hormone deficiency, pseudohypoparathyroidism.
  • Previous radiation of the pelvis, chemotherapy, renal osteodystrophy-induced bone dysplasia.

Symptoms of Slipped Capital Femoral Epiphysis

Symptoms of SCFE include:

  • Problems walking
  • Limping
  • Mild pain in the hips, groin or around the knees
  • Severe pain that makes children stops putting weight on the leg that hurts
  • Stiffness in the hip
  • Less movement than usual in the hip

Children may not have had any injury before the pain starts.

Slipped Capital Femoral Epiphysis Treatment

SCFE is a problem that needs urgent attention. If your child has SCFE, they will need surgery so that the ball does not slip off the bone any farther.
Surgery for Slipped Capital Femoral Epiphysis
During this operation, the doctor will probably reposition the slip in the hip. Then, he will make a small cut (incision) near your child's hip. A metal screw is placed through the bone and the growth plate in the cap of the femoral head. This helps make the bone stable. Often, children can leave the hospital on the same day as the surgery, or on the day after.
The goal of the treatment is to stabilize the ball and prevent it from moving any more. We do not try to put the bone back in place. Doing that could 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, they may need surgery to reposition the ball. This may improve motion and function of their hip.

Authored By: Dr. S. V. Santpure

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