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Slipped Capital Femoral Epiphysis (SCFE)

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents causing slippage or separation of the femoral head (ball at the upper end of the femur bone) from the weakened epiphyseal growth plate (growing end of the bone).This condition often develops during the rapid growth period after the onset of puberty, and may affect one or both legs at a time. The separation may be caused by an injury or other factors such as obesity and hormonal imbalances. SCFE commonly occurs in children between 11 and 15 years and boys are more likely to develop the condition than girls.

Causes and Risk Factors

The exact cause of SCFE remains unclear; however, the presence of certain factors may increase the risk of your child developing this condition. These include:

• Obesity: SCFE is more common in children who are obese and have rapid growth. This may be attributed to excess pressure on the growth plate
• Endocrine disorders such as diabetes, thyroid disease and growth hormone abnormalities (acromegaly)
• Kidney diseases
• Radiation therapy or chemotherapy for childhood leukemias
• Steroid medications
• Family history of the disorder

Types

SCFE is classified into two types, stable and unstable SCFE, based on the severity of pain and damage.

• Stable SCFE (mild slip): The condition is considered mild or stable if the child is having pain or stiffness in the knee or groin area but can manage to walk and may limp. Symptoms worsen with activity and subside with rest. In stable SCFE the child is able to walk with or without the help of crutches
• Unstable SCFE (severe slip): Any major blow such as a fall or sports injury may cause unstable SCFE. The child may have severe pain and stiffness that may limit movement. The child may not be able to walk or even put weight on the affected side

Diagnosis

Your doctor will diagnose the condition based on a careful medical history and physical examination where the walking pattern and hip movements will be monitored. X-rays of the hip confirm the diagnosis. Other imaging tests that may be ordered include:

• Bone Scanning: Bone scans help in the early detection of children at risk of avascular necrosis and chondrolysis, common complications of SCFE
• Computed Tomography Scan: Computed Tomography (CT) scans reveal the degree of slippage
• Ultrasonography: Ultrasound scan helps to distinguish between stable and unstable slip
• Magnetic Resonance Imaging Scan: Magnetic resonance imaging (MRI) scan may suggest possible complications such as avascular necrosis

Signs and Symptoms

Children with SCFE will exhibit certain characteristic symptoms that may even help the physician in assessing the type of SCFE. The signs and symptoms of stable SCFE include:

• Stiffness in the hip
• Pain in the groin, the thigh or the knee that lasts from several weeks to months
• Limping while walking
• Restricted movements of the hip
• Outward twisting of the leg

The signs and symptoms of unstable SCFE include:

• Severe pain similar to that felt during bone fracture
• Inability to move the affected leg

The goal of treatment in SCFE is to prevent progression or worsening of the slippage and is accomplished through surgery. Surgery is usually performed within 24-48 hrs of diagnosis.

Surgical Therapy

The surgical procedures available for correcting stable Slipped Capital Femoral Epiphysis include

• Internal fixation (pinning) Bone-graft epiphyseodesis
• Corrective osteotomy

Legg-Calve-Perthes Disease

Legg-Calve-Perthes Disease (LCPD) or Perthes disease is a disorder of the hip that affects children, usually between the ages of 4 and 10. It usually involves one hip, although it can occur on both sides in some children. It occurs more commonly in boys than girls.

The cause of Legg-Calve-Perthes Disease is not clearly known. It may occur due to inadequate blood supply to the ball of the hip joint (the femoral head) which leads to death of the bone. Over the course of several months, the blood supply returns back to the bone tissue and new bone cells gradually replace the dead bone over 2 - 3 years.

Some signs and symptoms of Perthes disease include:

• Walking with a limp (painless limp)
• Pain or stiffness in the hip, groin, thigh or knee
• Shortening of leg or unequal leg length
• Wasting of thigh muscles

Your doctor will make a diagnosis based on your child’s signs and symptoms, a thorough physical examination, imaging studies such as X-ray of the hip, and magnetic resonance imaging (MRI) scan.

Treatment

The goal of treatment for Perthes disease is to keep the femoral head snug in the socket portion of the joint. Nonsurgical treatment options may include rest, activity restrictions, anti-inflammatory medications, casting or bracing, and physical therapy. If nonsurgical treatments don't work, your child may need surgery. Surgery involves lengthening a groin muscle or reshaping the pelvis (osteotomy) depending on the severity of the condition and the shape of the femoral head.