Slipped Capital Femoral Epiphysis (SCFE)

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Slipped Capital Femoral Epiphysis (SCFE) is a condition in which the femoral head (the ball of the hip joint) slips off the neck of the femur through the growth plate (physis). It most commonly occurs in adolescents during periods of rapid growth.

Aetiology

The exact cause of SCFE is unknown, but several factors contribute to its development:

• Mechanical forces during periods of rapid growth
• Endocrine disorders (e.g., hypothyroidism, growth hormone abnormalities)
• Obesity
• Genetic predisposition
• Trauma or acute injury

Pathophysiology

The pathophysiology of SCFE involves:

• Weakening of the growth plate due to hormonal or mechanical factors
• Displacement of the femoral head relative to the femoral neck through the weakened physis
• Potential disruption of blood supply to the femoral head, leading to avascular necrosis if untreated

Risk Factors

• Age (typically occurs in adolescents)
• Male gender
• Obesity
• Endocrine disorders (e.g., hypothyroidism, growth hormone deficiency)
• Family history of SCFE
• Rapid growth spurts

Signs and Symptoms

The signs and symptoms of SCFE include:

• Hip, groin, thigh, or knee pain
• Limited range of motion in the hip
• Limping or altered gait
• Outward turning of the affected leg
• Shortening of the affected leg
• Muscle weakness in the affected leg

Investigations

Specific investigations to diagnose SCFE include:

• Clinical examination: Physical assessment of pain, gait, and range of motion.
• Imaging studies:
  • X-rays: To confirm the diagnosis and determine the degree of slippage. Standard views include anteroposterior (AP) and frog-leg lateral views.
  • MRI: May be used to detect early changes or complications such as avascular necrosis.
  • CT scan: In complex cases to provide detailed images of the hip joint.

Management

Primary Care Management

• Early recognition and referral: Prompt referral to orthopaedic services for further evaluation and management.
• Non-weight bearing: Advise the patient to avoid bearing weight on the affected leg to prevent further slippage.

Specialist Management

• In situ fixation: The most common surgical treatment involves the placement of a single screw to stabilise the femoral head and prevent further slippage.
• Open reduction and internal fixation: May be required for severe or unstable slips.
• Postoperative care: Includes physiotherapy to restore hip function and regular follow-up to monitor healing and detect complications.
• Management of complications: Such as avascular necrosis or chondrolysis, which may require further surgical or medical intervention.

References

1. NHS (2024) Slipped Capital Femoral Epiphysis (SCFE). Available at: https://www.nhs.uk/conditions/slipped-capital-femoral-epiphysis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Slipped upper femoral epiphysis. Available at: https://cks.nice.org.uk/topics/slipped-upper-femoral-epiphysis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Slipped capital femoral epiphysis: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2900 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Slipped Capital Femoral Epiphysis (SCFE). Available at: https://orthoinfo.aaos.org/en/diseases--conditions/slipped-capital-femoral-epiphysis/ (Accessed: 24 June 2024).

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