From the Guidelines
Slipped Capital Femoral Epiphysis (SCFE) is a hip disorder that requires immediate orthopedic consultation and typically involves surgical intervention with in-situ pinning to stabilize the femoral head and prevent further slippage, as this approach has been shown to improve outcomes and reduce the risk of complications such as avascular necrosis, chondrolysis, or early osteoarthritis 1. The condition typically affects adolescents during periods of rapid growth, more commonly boys than girls, and is often associated with obesity.
- The procedure involves placing one or more screws across the growth plate to hold the femoral head in position.
- Post-surgery, patients usually require crutches for 4-6 weeks with limited weight-bearing, followed by physical therapy to restore strength and range of motion.
- Early diagnosis and treatment are crucial to prevent complications, and monitoring of the unaffected hip is recommended as the condition may occur in both hips (bilateral) in up to 30% of cases.
- Pain management typically includes NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (250-500mg twice daily) for adolescents, with appropriate dosing adjustments based on age and weight. It is essential to note that osteonecrosis, which can be a complication of SCFE, is a condition that requires early diagnosis and treatment to prevent articular collapse and the need for joint replacements, as highlighted in the study on osteonecrosis 1.
From the Research
Definition and Diagnosis of SCFE
- Slipped capital femoral epiphysis (SCFE) is a common hip disorder among adolescents, whereby the epiphysis is displaced posteriorly and inferiorly to the metaphysis 2.
- SCFE is classified as stable or unstable based on the stability of the physis 3.
- Diagnosis is confirmed by bilateral hip radiography, which should include anteroposterior and frog-leg views in patients with stable SCFE, and anteroposterior and cross-table lateral views in unstable SCFE 3.
Treatment and Management of SCFE
- The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis, chondrolysis, and femoroacetabular impingement 3.
- Stable SCFE is usually treated using in situ screw fixation 3, 4.
- Treatment of unstable SCFE also usually involves in situ fixation, but there is controversy about timing of surgery and the value of reduction 3, 4.
- A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation 4.
Associated Conditions and Complications
- SCFE is associated with obesity, growth spurts, and (occasionally) endocrine abnormalities such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism 3.
- Patients with SCFE usually present with limping and poorly localized pain in the hip, groin, thigh, or knee 3, 5.
- SCFE can be associated with primary hyperparathyroidism, and an effective approach to management includes SCFE fixation followed by parathyroidectomy as soon as possible 6.