Slipped capital femoral epiphysis

What is the capital femoral epiphysis?

The capital femoral epiphysis is the head (top end) of the thigh bone (femur). An epiphysis is the end of a long bone. In children and teens who are still growing, the epiphysis is separated from the main part of the bone by a flat piece of cartilage, called the growth plate. When the bone stops growing, the cartilage in the growth plate is replaced by bone.

For more information, please see How Bones Grow in How the Body Works: Skeleton.

Slipped capital femoral epiphysis

What is a slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) occurs when the capital femoral epiphysis slips down and backward in relation to the neck of the femur. Another way to describe SCFE is like a scoop of ice cream slipping off the top of a cone. This slippage can be either gradual or sudden.

SCFE is the most common hip disorder in teens.

A child with SCFE will probably need an operation. This information explains what to expect before, during and after the operation. Share and discuss it with your child so that they know what to expect.

SCFE is classified in two ways

The first way to classify SCFE is by how long the person has had symptoms:

• Acute: symptoms began suddenly (less than three weeks ago).
• Chronic: the person has had symptoms for more than three weeks, sometimes for years.

The second way is by the stability of the slip:

• Stable slip: The person can usually walk, at least with crutches.
• Unstable slip: This is like a fracture. It is so painful that the person cannot walk at all.

Symptoms of SCFE

The symptoms of SCFE depend on the type of slip:

• If the slip is mild and stable, the person may only experience mild pain in the groin area and a slight limp that increases with activity. They may also experience pain in the lower thigh or knee area, with or without groin pain.
• With chronic slips, the person may have pain on and off over several months.
• With acute slips, the person may have immediate pain and walk with a limp or have trouble walking. The person may also walk with the leg turned outward.
• Unstable slips usually occur when the person has some type of injury that makes the femoral head slip suddenly. The person will not be able to walk or bear any weight on that leg.

Sometimes slips happen on both sides but the person only feels the symptoms on one side. For this reason, it is very important that your child's health-care provider checks both hips.

We do not know what causes SCFE

The cause of SCFE is unknown. We do know that a person is more likely to develop it if they have one or more of these risk factors:

• Obesity
• Endocrine problems, such as thyroid issues
• Trauma (injury)
• Certain medicines, such as steroids
• Radiation treatment
• Chemotherapy
• Bone problems related to kidney disease

How SCFE is diagnosed

SCFE is usually diagnosed with an X-ray of both hips.

Rarely, magnetic resonance imaging (MRI) or CT scans are used to diagnose a very mild slip or "preslip" that cannot be seen on an X-ray.

How SCFE is treated

There are two immediate goals of treatment:

1. to prevent the bone from slipping further
2. to prevent damage to the blood supply to the bone

Your child will probably need surgery (an operation). Your surgeon will talk with you and your child about the best treatment. This will depend on the type of slip:

• If the head of the femur has slipped very little (less than 1 cm), it will be surgically fixed (secured) in that position with a single screw through a small incision (cut) in the skin.
• If the slip is more severe, the surgeon will need to adjust the hip. They may need to use one or two screws to stabilize it and prevent further slippage.
• For severe, unstable slips, the surgeon may need to open the hip joint and put the head of the femur back into the correct position before securing it.

Before the operation

Your child may or may not stay in hospital for one to five days, depending on the operation. Ask the nurse what to bring with you for your child's stay in hospital. For more information, visit the Coming for Surgery Learning Hub.

Several hours before the operation, your child will need to stop eating and drinking. The health-care team will tell you when your child must stop eating and drinking.

Your child will have a general anesthetic

Just before the operation, your child will be given a special sleep medicine called a general anesthetic. This makes sure that your child will sleep through the operation and will not feel any pain.

After the operation

The operation will last two to three hours.

After the operation, your child will be taken to the recovery room, also called the post-anaesthetic care unit (PACU). This is where your child will wake up. Your child will stay in the PACU for about one hour or until your child is awake. The health-care team will then move your child to a room on the nursing unit.

You will be able to see your child when they are fully awake. A staff member from the surgical waiting area will bring you to your child.

Your child will get fluids through a tube in their arm, called an intravenous (IV) line until they are able to drink easily. Your child will have a bandage on their hip and thigh.

Your child may stay in hospital for one to five days, depending on the operation.

Managing post-operative pain

At first, your child will receive medicine for pain through the IV. When the pain is under control and your child can drink fluids, they will be given pain medicine by mouth as needed. If your child is in pain, tell the nurse.

Caring for your child after the operation

Your child will have a small or large gauze bandage (depending on the type of operation) on the affected thigh and hip area. Your child's nurse will check it for bleeding. The bandage will be changed before your child goes home.

The nurse will check your child's leg for movement, feeling and blood circulation.

The nurse will check your child's temperature, pulse, blood pressure and breathing every hour for the first four hours, and then every four hours until your child goes home. Your child will also be asked to rate their pain, using an age-appropriate pain scale.

Starting the first day after surgery, your child will see a physiotherapist to learn how to use crutches. Your child will need to use crutches for six weeks after the surgery. Your child may have pain when walking and moving.

Your child's surgeon will explain how much weight your child can put on the affected leg.

How to take care of your child at home

Your child will go home with a band-aid or a gauze dressing. Your child will need to take sponge baths instead of regular baths or showers until this dressing is removed.

You can take the dressing off three to five days after the date of surgery. When the dressing is off, your child can take showers.

Managing pain

The surgeon will prescribe medicine for pain, such as morphine. If your child has pain, please give this medicine as prescribed. Some pain medicine may cause constipation. To help with this, make sure your child drinks more fluid (liquids) than usual and give your child more fibre in their diet. Foods that are high in fibre are fresh fruit, vegetables and bran.

You can also give acetaminophen or ibuprofen for pain with the prescribed medicine. Sometimes your child will only need acetaminophen.

Activity and crutches

Your child will have to use crutches for six weeks. To ensure your child does not slip, make sure your child is wearing good rubber-soled shoes and that the bottoms of the crutches are clean.

Your child can go back to school once they feel that they can walk safely with the crutches.

When to call the health-care team

Call your child's health-care team if your child has any of the following symptoms:

• redness, swelling or green or yellow drainage from the incision
• more pain
• pain in the other hip

If you have any concerns about your child's condition, do not wait. Take your child to the closest emergency department.