A great, stable connection at the hip joint is what lets us walk, run, jump, and many other things. However in some kids– particularly those who are obese– the thighbone and the hipbone are a little less well linked than they must be since of a condition called slipped capital femoral epiphysis (SCFE). SCFE is a shift at the upper part of the thighbone, or thigh, that results in a weakened hip joint.
Fortunately, when caught early, most cases of SCFE can be treated successfully.
Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For factors that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in an in reverse instructions. This causes pain, tightness, and instability in the affected hip. The condition generally establishes slowly with time and is more typical in kids than girls.
About Slipped Capital Femoral Epiphysis
To comprehend SCFE, it assists to know a little about the hip joint. The hip is a ball-and-socket joint, which means that the rounded end of one bone (in this case, the “ball” of the thighbone) suits the hollow of another bone (the acetabulum, or cup-shaped “socket” of the hips). Ball-and-socket joints provide the best series of motion of all types of joints, which explains why we can move our legs forward, backward, and all around.
Kids and teens who are still growing likewise have a development plate at the top of the thighbone, simply under the “ball” part (likewise called the femoral head) of the joint. This development plate is called the physis and it’s made from cartilage, which is weaker than bone. The job of the physis is to connect the femoral head to the thighbone while enabling the bone to extend and grow.
In SCFE, the femoral head of the thighbone slips through the physis, nearly the method a scoop of ice cream may slip off a cone. Sometimes this occurs suddenly– after a fall or sports injury, for instance– but often it takes place gradually without any prior injury.
Generally, SCFE is categorized as:
- Stable SCFE. A stable SCFE causes some tightness or pain in the knee or groin area, and potentially a limp that causes a child to walk with a foot external. The pain and the limp typically have the tendency to reoccur, worsening with activity and improving with rest. With stable SCFE, a child still can walk, even if crutches are needed.
- Unstable SCFE. An unstable SCFE is a more severe slip that typically takes place suddenly, and is typically far more painful. A child will not be able to bear weight on the afflicted side. An unsteady SCFE is also more severe due to the fact that it can limit blood flow to the hip joint, resulting in tissue death in the head of the femur.
Often SCFE can irritate the nerves that run down the leg, causing referred pain (pain that starts in one part of the body however is felt in another). In this case, pain starts in the unusual hip joint however is felt in the typical knee joint.
Some cases of SCFE impact just one hip, however lots of are ultimately found to affect both hips (be bilateral). When SCFE impacts one hip, physicians might closely see the other to see if it develops SCFE; or, if that’s considered very likely, they might treat both hips at the very same time. Capturing SCFE early makes a big distinction in how easily physicians can treat it.
Causes of SCFE
Nobody knows for sure what causes SCFE. But most cases remain in kids between 11 and 16 years of ages who are going through a development spurt. SCFE is more typical in young boys, though girls can be affected, too.
SCFE is also most likely in kids who have these risk factors, all of which can impact bone health:
- obesity (bring extra weight puts increased pressure on the development plate)
- endocrine conditions such as diabetes, thyroid disease, or development hormonal agent issues
- kidney disease
- cancer treatments like radiation and chemotherapy
- particular medications, such as steroids
- a household history of SCFE
A child thought to have SCFE will see an orthopedic doctor, a professional in the treatment of bones. The doctor will do an extensive 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 search for any displacement at the head of the thighbone.
In uncommon cases, X-rays will return normal, but the pain, tightness, and other problems will still exist. In these cases, a magnetic resonance imaging research study (MRI) may be ordered. An MRI can capture really early SCFEs, before they begin to slip extremely far.
SCFE is constantly treated with surgery to support the growth plate that slipped. However even before the surgery, the doctor will try to prevent any more slipping by motivating rest and the use of crutches to avoid putting weight on the affected leg. Many doctors recommend admission to the healthcare facility as soon as the SCFE is found to make sure the patient rests, therefore surgery can be done as quickly as possible.
Surgery for SCFE is done under basic anesthesia (when a patient is entirely asleep). Using a fluoroscope– an unique X-ray device that produces a real-time image of the hip on a TELEVISION screen– as a guide, the cosmetic surgeon will make a tiny incision near the hip, then put a metal screw through the bone and throughout the development plate to hold it in location. The screw is positioned deep into the bone, and can not be felt by patients after surgery.
Due to the fact that some patients have a high risk of an SCFE in the other hip, the cosmetic surgeon might likewise support that side too, even if it hasn’t slipped yet.
Doctors choose how much weight can be put on the affected leg after surgery based upon the intensity of the slip. Patients usually can walk with crutches, but those who have actually both hips dealt with might need to use a wheelchair for the first few weeks after surgery.
The majority of kids succeed when SCFE is caught and treated early. Doctors will continue to order follow-up X-rays to monitor the condition. In the majority of cases, more surgery isn’t required.
Nevertheless, kids with unsteady SCFEs have a higher possibility of establishing other issues later, such as stiff hips, early arthritis, leg length differences, or avascular necrosis (where part of the “ball” dies from absence of blood supply). They’re also more likely to need additional surgery to take care of their hip.
Not everybody can avoid SCFE. But reaching and preserving a healthy weight can spare bones and joints from the excess wear and tear that can compromise and harm them. If your child is obese and you need help developing a safe diet and exercise plan, speak with your child’s doctor.