Slipped Capital Femoral Epiphysis By Kids Orthopedic

SLIPPED CAPITAL FEMORAL EPIPHYSIS BY KIDS ORTHOPEDIC

ABOUT THE DISEASE

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.

This causes pain, stiffness, and instability in the affected hip. The condition usually develops gradually over time and is more common in boys than girls.

Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. To achieve the best outcome, it is important to be diagnosed as quickly as possible.

Without early detection and proper treatment, SCFE can lead to potentially serious complications, including painful arthritis in the hip joint.

ANATOMY

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

Like the other long bones in the body, the femur does not grow from the centre outward. Instead, growth occurs at each end of the bone around an area of developing cartilage called the growth plate (physis).

Growth plates are located between the widened part of the shaft of the bone (metaphysis) and the end of the bone (epiphysis). The epiphysis at the upper end of the femur is the growth centre that eventually becomes the femoral head.

SCFE usually develops during periods of rapid growth, shortly after the onset of puberty. In boys, this most commonly occurs between the ages of 12 and 16; in girls, between the ages of 10 and 14.

Sometimes SCFE occurs suddenly after a minor fall or trauma. More often, however, the condition develops gradually over several weeks or months, with no previous injury.

SCFE is often described based on whether the patient is able to bear weight on the affected hip. Knowing the type of SCFE will help your doctor determine treatment.

TYPES OF SCFE

STABLE SCFE In stable SCFE, the patient is able to walk or bear weight on the affected hip, either with or without crutches. Most cases of SCFE are stable slips.

UNSTABLE SCFE This is a more severe slip. The patient cannot walk or bear weight, even with crutches. Unstable SCFE requires urgent treatment. Complications associated with SCFE are much more common in patients with unstable slips.

SCFE usually occurs on only one side; however, in up to 40 percent of patients (particularly those younger than age 10) SCFE will occur on the opposite side, as well—usually within 18 months.

CAUSES OF SCFE

No one knows for sure what causes SCFE. But most cases are in kids between 11 and 16 years old who are going through a growth spurt. SCFE is more common in boys, though girls can be affected, too.

SCFE is also more likely in kids who have these risk factors, all of which can affect bone health:  obesity (carrying extra weight puts increased pressure on the growth plate)  endocrine disorders such as diabetes, thyroid disease, or growth hormone problems  kidney disease  cancer treatments like radiation and chemotherapy  certain medicines, such as steroids  a family history of SCFE

SIGNS AND SYMPTOMS

Usually, a SCFE causes groin pain, but it may cause pain in only the thigh or knee, because the pain may be referred along the distribution of the obturator nerve. The pain may occur on both sides of the body (bilaterally), as up to 40 per cent of cases involve slippage on both sides.

After a first SCFE, when a second SCFE occurs on the other side, it typically happens within one year after the first SCFE. About 20 per cent of all cases include a SCFE on both sides at the time of presentation.

Signs of a SCFE include a waddling gait, decreased range of motion. Often the range of motion in the hip is restricted in internal rotation, abduction, and flexion. A person with a SCFE may prefer to hold their hip in flexion and external rotation.

DIAGNOSIS

A child thought to have SCFE will see an orthopaedic doctor, a specialist in the treatment of bones. The doctor will do a thorough physical examination, checking the range of motion of the hips and legs and seeing if there is any pain. The doctor will also take X-rays of the hips to look for any displacement at the head of the thighbone.

In rare cases, X-rays will come back normal, but the pain, stiffness, and other problems will still be there. In these cases, a magnetic resonance imaging study (MRI) might be ordered. An MRI can catch very early SCFEs, before they start to slip very far.

MRI

TREATMENT

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on the condition. The goal of treatment is to prevent the femoral head from slipping further off the thighbone. Treatment may include:

SURGERY This treatment may involve the use of a steel pin or screw to hold the femoral head onto the thighbone to stop it from slipping further.

PHYSICAL THERAPY

After surgery, physical therapy can help build up the hip and leg muscles.

Children with severe cases of SCFE are more likely to have limited hip motion, differences in leg lengths, and other hip problems in adulthood. But with early detection and proper treatment, a good outcome with few problems is possible.

RECOVERY

Once the surgery is over, the child can walk with crutches after a few days.

But the child has to use a wheelchair for several weeks if both his hips are treated surgically.

The orthopaedic still keep monitoring the condition by recommending follow up Xrays. The child can use his legs and hips normally if SCFE is diagnosed and treated by skilled orthopaedic without any delay.

COMPLICATIONS

Failure to treat a SCFE may lead to: death of bone tissue in the femoral head (avascular necrosis), degenerative hip disease (hip osteoarthritis), gait abnormalities and chronic pain.

SCFE is associated with a greater risk of arthritis of the hip joint later in life. 17–47 per cent of acute cases of SCFE lead to the death of bone tissue (osteonecrosis) effects.

KIDS ORTHOPEDIC Dr. Soumya Paik has a clinical fellowship in Paediatric Orthopaedics from National University Hospital (NUH), Singapore. He has treated many a Paediatric Orthopaedics cases successfully. Visit our official website to get more details about the different diseases.

Get treated from Slipped Capital Femoral Epiphysis, feel free to call us at “+91 9051148463� or mail us at drsoumyapaik@gmail.com . We serve in Kolkata, India.

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