Slipped Capital Femoral Epiphysis (SCFE) in adolescents - Parents, are you aware of this?

Imagine your child, usually between the ages of 11 and 16, suddenly starts walking with a limp, as if dragging his leg a little. Or he keeps saying, "Mommy, my knee hurts" while playing. We often think as parents, "Oh... this kid is growing up, that's what it must be." But it's not a good idea to just ignore every limp, every leg pain. Because it could be a symptom of a condition called Slipped Capital Femoral Epiphysis , or SCFE as we doctors call it. This is a serious condition that needs immediate attention. So today, let's talk about what SCFE is, why it happens, and what we should do.

Simply put, what is this slippage of the hip (SCFE)?

Although this name may sound a bit scary and complicated, let's keep it simple.

The longest and strongest bone in our upper leg is the thigh bone, or in medical terms, the Femur . At the top of this thigh bone is a round, ball-like part. We call this the Capital Femoral Epiphysis . Think of it like the ice cream ball on an ice cream cone. This ball is what sits in our hip socket and helps us turn, bend, and walk.

When a child is young, that is, when the body is growing rapidly, there is a "growth plate" between the ball-like part of this bone and the rest of the long part of the bone. This is what helps the bone to grow. But because this growth plate is made of cartilage, it is not as strong as a fully grown bone. It is a little weaker.

In a condition called SCFE , the ball-shaped bone head slips out and down through this weak growth plate, like an ice cream cone, away from the rest of the femur. This causes the ball to not fit properly in the socket of the hip bone. This can cause the child to have difficulty walking, experience pain, and develop a limp.

There are two main types of this SCFE condition:

Doctors divide this condition into two main types based on its severity and the discomfort the child experiences. It is very important to know the difference between the two, as this determines the type of treatment and its urgency.

What symptoms can we see in the child?

SCFE, especially Stable SCFE, can be a little difficult to recognize at first. Symptoms come on very slowly. It may start in one hip and then spread to the other. As parents, we need to be aware of these symptoms.

Why does this happen to children? Causes and risk factors

There is no single cause of SCFE, but doctors have identified several major causes and risk factors that contribute to it.

• Obesity: This is the most important and powerful risk factor for SCFE. Most children with SCFE have a high body mass index (BMI) for their age. Simply put, as body weight increases, the pressure on the weak growth plate increases. When this pressure cannot be tolerated, the bone head is more likely to slip.
• Growth spurts: This condition is most common during periods of rapid growth, when the child's body suddenly grows taller and faster. During this time, the growth plate is very active, but also weak.
• Hormonal changes: During puberty and due to obesity, hormone levels in a child's body change. These hormonal changes can affect the growth and strength of bones, further weakening the growth plate. Some endocrine disorders can also increase this risk.
• Family history (Genes): If someone in the family, that is, a mother, father, or sibling, has had SCFE, there is a small risk that the child will also develop it.
• Minor Injuries: Sometimes, something like a fall or a blow to the hip can start this slippage or make an existing condition worse.

Complications that may occur if this condition is not treated

SCFE is not something that can be treated easily. If not recognized in time and properly treated, it can lead to long-term, serious problems.

1. Hip Impingement: When the femoral head slips, the bones in the hip joint begin to rub against each other. This causes severe pain, damages the cartilage lining of the joint, and can lead to arthritis over time.

2. Avascular Necrosis: This is the most serious complication. If the bone head slips too far or in an unstable SCFE, the delicate blood vessels that supply blood to the bone head can be damaged. If this happens, the blood supply to the bone stops and the bone tissue begins to die. This is a very painful condition and can even lead to a total hip replacement surgery in the future.

How does a doctor diagnose this?

When you take your child to the doctor, he or she will first ask you and your child about the symptoms in detail. How long the pain has been present, how it feels, and whether it is difficult to walk.

Then the child is examined. The child is watched as he walks, the length of his legs is measured while he is lying down, and the hip joint is bent and rotated in different directions to see how it moves and whether there is pain. When a child with SCFE bends his leg upwards, it automatically rotates outward. This is an important sign to identify this disease.

After this physical examination, an X-ray is performed to confirm the diagnosis. An X-ray of the hip joint can clearly show whether the femoral head has slipped and how far it has slipped. In some rare cases, an MRI scan may also be performed.

Treatment methods: Surgery is mandatory!

Once SCFE is diagnosed, treatment is almost always surgery . It's not a matter of taking medication and resting. Surgery has two main goals:

1. Stop the bone head from slipping further.

2. Keeping the bone head stable.

There are two main types of surgery.

• In Situ Fixation: This is the most common and successful method for stable SCFE. This involves making a small incision on the side of the femur, and using X-ray guidance, a single strong screw is inserted through the slipped head of the femur, securing the head of the femur to the rest of the femur. This is a relatively simple, minimally invasive procedure.
• Open Reduction and Internal Fixation: This is a more complicated surgery. It is done in cases of unstable SCFE, meaning that the femoral head has slipped too far. In this case, the surgeon has to open the hip joint, move the femoral head back into place, and fix it with more than one screw.

What happens after the surgery?

After the surgery, the child will need to use crutches for about 6-8 weeks and not put any weight on the operated leg. Once the pain has subsided and the bone has healed, it is essential to seek the help of a physiotherapist . He or she will teach you exercises to strengthen the muscles around the hip joint and restore mobility to the joint. It may take about 3-6 months to fully heal and resume sports activities.

SCFE, Slipped Capital Femoral Epiphysis, Slipped hip, Children's leg lameness, Adolescent bone diseases, Knee pain, Pediatrics, Bone surgery