What is SCFE?June 6, 2019
Slipped capital femoral epiphysis or SCFE is a condition that occurs mostly in preadolescent or adolescent children. It is typically more common in boys but girls can be diagnosed as well. Other factors that contribute to SCFE are obesity, taller children, and having a recent growth spurt. To further understand why these are common factors in children diagnosed with SCFE, we must first define SCFE. Slipped capital femoral epiphysis is a condition in which the epiphysis of the femur or thigh bone is displaced or has slipped off the neck of the femur.
The exact cause of a SCFE is unknown but some proposed reasons include some sort of trauma such as jumping and landing hard on one leg, shear forces at the hip joint, inflammatory processes, as well as after radiation or chemo treatments which may weaken or affect the growth plate.
There are three different classification and grades of slippage. First, the classifications include acute, acute-on-chronic, and chronic. Acute slippage is the most severe and may also be referred to as unstable. This is type is most likely caused by trauma and is associated with sudden and severe pain. Acute-on-chronic is where a slip may have begun and is associated with chronic hip aching and then a specific event causes an increase in slippage and symptoms worsen. Lastly, chronic is the most common and this type occurs over time. Children may present with chronic pain, a limp, and a loss of hip range of motion. The grades of slippage are grade I, grade II, and grade III. Grade I being the least amount of slippage and grade III being a slippage of greater than 50%.
Your child may complain of pain in their groin, thigh, or knee. They may also have a limp as well as keeping their leg in an externally rotated position where their toes point outward. They may also complain of limited range of motion at the hip which may prevent them from putting their leg in certain positions. If your child is experiencing any of the signs and symptoms above and is a preadolescent or adolescent, it is important to contact your physician right away.
Depending on the classification and degree of slippage, your physician may recommend surgery to stabilize the capital femoral epiphysis and prevent and further slippage and complications associated with this condition. If your physician recommends surgery, a pin or screw may be placed to hold the epiphysis in place.
Following surgery, your child will be referred to a physical therapist. During the initial period after surgery when your child may not be able to put weight on the operated leg, the physical therapist may teach your child how to properly use crutches, teach them how to transfer from a sitting position to a standing position, and teach them upper extremity exercises while they are using the crutches. After your child can put weight onto their operated leg, the physical therapist will begin range of motion exercises to regain any lost range of motion at their hip as well as maintain their current range of motion measurements. In addition, their therapist will begin leg and hip strengthening exercise to keep the leg strong while recovering from surgery and regain any lost strength from surgery and time spent not weight bearing through that leg. Lastly, the physical therapist will assess the way your child walks and teach your child how to walk properly to ensure they don’t develop any walking abnormalities.