Doctors refer to it by its acronym, SCFE, pronounced “skiffy:” a jaunty-sounding name for a painful and potentially debilitating condition. What is slipped capital femoral epiphysis, how is it diagnosed and treated, and what happens if it is not caught in a timely fashion?
Let’s start with the basics: SCFE is a hip disorder that occurs most often in children between the ages of 8 and 15. It is a relatively uncommon condition, occurring in about 10.8 out of every 100,000 children.
The femur is the bone in the upper leg, and it is the longest, strongest, and heaviest bone in the human body. That’s important, because the weight of the upper body rests on the heads of the two femur bones. Growth plates are the areas of tissue near the ends of long bones (like the femur) in children and adolescents. When the growth plate is damaged, the head of the femur (femoral head) “slips” in relation to the rest of the femur. Essentially, the head of the femur remains in the “cup” of the hip joint, and the rest of the femur shifts.
If not diagnosed in a timely manner, the head of the femur eventually breaks off, like a scoop of ice cream sliding off the top of a cone. This is terribly painful and can lead to permanent disability.
Doctors don’t have a good answer for what causes SCFE, but there are some known risk factors. Boys are more likely to suffer from the disorder than girls. Obesity is a major risk factor for the condition, as are certain endocrine conditions like hypothyroidism and osteodystrophy. Because this rare condition tends to run in families, there is probably a genetic component.
Parents usually start to seek answers when their child complains of pain in the knee, inner thigh, or groin area. The child may have stiffness in the leg and reduced ability to rotate the leg. As the child tries to avoid pain, they may “favor” the affected leg, putting as little weight on it as possible; this can cause a limp or change in gait. Some children tend to walk with their leg rotated outward.
The onset of symptoms is usually fairly gradual, and parents may initially chalk them up to “growing pains,” especially because they sometimes emerge around the same time as a growth spurt. In other cases, the onset of pain or a limp may be more sudden, especially if the child has experienced a fall or other minor trauma.
A child with SCFE will often be seen initially by their pediatrician, who may then refer them to a pediatric orthopedist. The orthopedic specialist should take a complete medical history and conduct a thorough physical examination before ordering further testing. Typically, an x-ray is needed to make a conclusive diagnosis. If the x-ray does not clearly rule out or show SCFE, the orthopedist may order an MRI.
Naturally, it is ideal to diagnose SCFE before the femoral head breaks from the femur. Treatment is intended to keep the head of the femur from slipping any further. This typically involves surgery to place pins or screws connecting the femoral head with the rest of the bone, realigning the bones if necessary.
If one hip is affected but the other is not, the orthopedic surgeon may recommend placement of screws in the unaffected hip to prevent future problems. Most cases of SCFE are “stable” and surgery is scheduled from a few days to two weeks after diagnosis. In the most severe, “unstable” cases, surgery may need to be performed immediately.
Between diagnosis and surgery, the child should rest the affected leg and avoid bearing weight on it as much as possible. After surgery, the child may need to use a walker or crutches for a time to allow the leg to heal before putting weight on it.
As mentioned above, failure to diagnose this disorder in a timely fashion can lead to severe complications, which include osteonecrosis (“bone death”). In short, the condition interferes with the blood supply to the head of the femur, and the bone dies as a result. Osteonecrosis can lead to painful and disabling degenerative joint disease.
Another potential complication is called chondrolysis, in which the cartilage of the joint is damaged. The joint becomes painful and stiff, limiting the sufferer’s ability to to work and engage in ordinary physical activities.
SCFE may not be common, but it is the most common hip problem in adolescents. Pediatric orthopedists should be aware of the condition and have it on their radar screen if a young patient presents with symptoms, especially if there are common risk factors present. Testing for the condition is usually fairly straightforward. Failure to examine the hip area, to order appropriate testing, or misinterpreting radiology results may constitute medical malpractice.
A child may face a long lifetime of pain and disability after a doctor fails to diagnose or properly treat SCFE, with limited mobility and ability to work, and to simply enjoy ordinary activities like sports and travel. If a child with SCFE suffers a worse outcome due to medical malpractice, their damages could be significant. It can be difficult to know what further medical treatment and support your child will need over their lifetime, but the people responsible should help to bear that expense. Unfortunately, you have only a limited amount of time to file a claim for medical malpractice.
If your child suffers from slipped capital femoral epiphysis, and you feel that their doctor did not properly diagnose or treat the condition, we invite you to contact The Fraser Law Firm P.C. to schedule a consultation to discuss your child’s options.
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