Slipped Capital Femoral Epiphysis Treatment, Surgery
The treatment and surgery that is right for a slipped capital femoral epiphysis (SCFE) depends on a number of factors, including a child’s age, their past and present health, the severity of the injury and their history with other medications and treatments. Slipped capital femoral epiphysis, which is a slippage of the thighbone from the hip socket, is unusual but not rare.
Slipped Capital Femoral Epiphysis Diagnosis
A slipped capital femoral epiphysis can make walking difficult and will worsen over time if not treated. If you have any reason to suspect that your child has this injury, it is important to seek medical attention. To diagnose your child, the doctor will talk to you and your child about recent trauma (if any) and perform a physical exam. To further determine the right diagnosis and treatment method, the doctor may perform one of the following:
- X-Ray (Radiograph) – This is usually the first and only imaging test performed. It shows the bone structure on an image transposed in black and white, which exposes the location of the fracture. Radiation passes through your child’s body and is used to produce images of their pelvis and thighbone in order to look for any abnormalities, slippage, or fractures. Bone stands out in a radiograph because it absorbs the radiation.
- Magnetic Resonance Imaging (MRI) – In some cases, an X-ray may not show the slippage clearly so a doctor will order an MRI. This test is performed by placing the child in a vessel that, through vibrations caused by magnets, displays a high-definition computer image.
Nonsurgical Treatment for Slipped Capital Femoral Epiphysis
It is rare that a child will not require surgery when they have experienced a slipped capital femoral epiphysis. This is because there are risks involved with letting the injury repair itself, such as further slippage which can lead to blood loss and complications. In all cases, the child will be put on bed rest immediately and be advised to not apply any weight to the side where the slippage occurred. However, in some mild cases traditional methods of fracture repair may be used, such as casting the bone. This is still being researched.
Surgery for Slipped Capital Femoral Epiphysis
In nearly every case, regardless of severity, a slipped capital femoral epiphysis necessitates surgery. Studies have shown that trying to allow the bone to repair naturally can lead to further complications, so surgery is the best method for repair. The goal of the surgery is to prevent any further slippage which could lead to more complications. Depending on the severity of the injury, the following techniques may be used:
- In-situ Fixation – This is when the slippage is stopped by screwing the bone into the area where the slippage occurred. If the slippage is minor or caught early, it can often be stopped by placing a single screw in the femoral head and through the growth plate.
- In-situ Fixation with Multiple Screws – If the slippage is more moderate, more than one screw may be needed to hold the slipping femoral head in place.
- Removing the Abnormal Growth Plate – When the growth plate has been damaged beyond repair, it may need to be removed to prevent further complications.
- In-Situ Fixation on the Healthy Hip – While surgery on a healthy bone is not usually advised, it is often recommended in cases with a high likelihood that the other hip will also slip over time.
Slipped Capital Femoral Epiphysis Research
Because there is still not a lot known about the cause of slipped capital femoral epiphysis, much of the research surrounds finding the cause and determining a treatment that is less invasive.
Because slipped capital femoral epiphysis is one of the most common hip diseases in children, it is of concern to many doctors that no cause is known for why or how this injury happens. In some recent studies, the case has been made that genetics might be involved with the slippage due to the similarities between at-risk patients. However, a recent study performed by Johns Hopkins Department of Orthopedic Surgery showed that genetics are not to blame for this disease. Instead, further studies have shown a familial correlation between children of the same generation. This study looked at three separate cases where three sets of Caucasian sisters, who are not at a known higher risk of developing this disease, had it occur at similar times. These sisters, furthermore, were in excellent health, had no endocrine abnormalities, and were not overweight.
The study shows the importance of mindfulness about the disease and the continued observation of people who contract slipped capital femoral epiphysis to help find a common link as to the cause. This is also crucial so that the disease is not mischaracterized and therefore not treated quickly enough because of the belief that a child is not in the at-risk group and so is less likely to have it.
As research on the cause of slipped capital femoral epiphysis is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute's Trauma Services in New York performs slipped capital femoral epiphysis surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.