A condition in adolescents where the growth plate at the top of the femur slips out of position. Almost always requires urgent surgery to stabilise the hip.
Slipped capital femoral epiphysis, SCFE, is a condition in which the growth plate at the top of the thigh bone slips out of position. The 'ball' of the hip joint moves backwards relative to the rest of the bone, changing the mechanics of the hip.
It's most common in early adolescence, typically between 10 and 15, and is more common in children who are overweight. It can affect one or both hips.
SCFE is one of the few paediatric orthopaedic conditions that genuinely needs urgent attention. Once the diagnosis is suspected, prompt assessment and treatment are important to prevent further slip and minimise long-term consequences.
Symptoms can be acute, gradual, or a mixture of both. Common features include:
Hip, groin, thigh or knee pain, knee pain is a classic but often misleading presentation
A limp
An altered gait, sometimes with the leg turned outwards
Difficulty bearing weight in more severe cases
Pain that's been grumbling for weeks or months in some children, or sudden in others
Knee pain in an adolescent without a clear knee diagnosis should prompt assessment of the hips. SCFE is regularly missed because the pain is referred and the hip examination is overlooked.
Examination typically reveals restricted internal rotation of the hip: a useful clue. The diagnosis is confirmed with imaging.
X-rays of both hips, including a specific view, are the standard. Both hips are imaged because SCFE can be bilateral and the second hip may slip without obvious symptoms. MRI is occasionally used in pre-slip or early cases.
Once the diagnosis is suspected, weight-bearing should be restricted until imaging clarifies the picture, continuing to walk on a slipping hip can make the slip worse.
SCFE is almost always treated surgically, with the goal of stabilising the slip and preventing further movement. The standard procedure involves placing a screw across the growth plate to hold things in position while healing occurs.
In severe slips, more involved surgery may be needed. There's also a long-running discussion about whether to treat the other (apparently normal) hip prophylactically: this is an individual decision based on risk factors. Nev will work through this with you and your child at your consultation.
Seek prompt assessment if:
Your adolescent has hip, groin, thigh or knee pain without a clear cause
There's a limp or altered gait
Your child has been told they have knee pain but it isn't making sense
There's reluctance to bear weight on one leg
You're worried something doesn't add up
SCFE is a time-sensitive diagnosis. The earlier it's identified and treated, the better the outcome, and the lower the risk to the other hip in the medium term.
