Slipped capital femoral epiphysis
Slipped capital femoral epiphysis
Description, Causes and Risk Factors:
Slipped capital femoral epiphysis (SCFE) is an unusual disorder of the adolescent hip. It is not rare. For reasons that are not well understood, the ball at the upper end of the femur (thigh bone) slips off in a backward direction. This is due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.
Usually, SCFE is classified as:
Unstable SCFE. This is a more severe slip that is usually much more painful. A child might not be able to bear weight on the affected side, and because range of motion tends to be severely limited, the affected foot and leg might begin to turn outward. An unstable SCFE is also more serious because it can restrict blood flow to the hip joint, leading to tissue death in the area.
Stable SCFE. This is referred to as a "mild slip," which causes a child to experience some stiffness or pain in the knee or groin area, and possibly to develop a limp. The pain and the limp usually tend to come and go, worsening with activity and getting better with rest. With stable SCFE, a person is still able to walk (sometimes with crutches).
No one knows for sure what causes SCFE. However, it is known that it mostly occurs in kids between 11 and 16 years old who are going through a growth spurt. It's more common in boys, though girls can be affected, too. It's also more likely to happen in kids who have the following risk factors, all of which can have an affect on bone health:
Endocrine disorders such as diabetes, thyroid disease, or growth hormone problems.
Cancer treatments like radiation and chemotherapy.
Certain medications, such as steroids.
A family history of SCFE.
Prevalence of slipped capital femoral epiphysis varies widely even within the continental United States. Prevalence has been reported to be 2.13 cases per 100,000 population in the southwestern United States and 10.08 cases per 100,000 population in the northeastern United States. Prevalence is lowest in the mountain and Great Plains states. Prevalence is reported to be quite low in Asia, with just 0.2 cases per 100,000 children affected in eastern Japan.
The typical patient has a history of several weeks or months of hip or knee pain and an intermittent limp. The appearance of the adolescent is characteristic. He or she walks with a limp. In certain severe cases, the adolescent will be unable to bear any weight on the affected leg. The affected leg is usually turned outward in comparison to the normal leg. The affected leg may also appear to be shorter.
A child suspected of having SCFE will need to see an orthopedic doctor, a specialist in the treatment of bones. The doctor will perform a thorough physical examination, checking the range of motion (ROM) of the hips and legs and seeing if there is any pain. He or she will also take X-rays of the hip to look for a displacement at the head of the thighbone.
Sometimes, though, the X-rays will come back normal even when symptoms are present. In these cases, a magnetic resonance imaging (MRI) study or bone scan (BS) will likely be ordered. Both are more sensitive than an X-ray. The MRI, in particular, has the ability to highlight contrasts in soft tissue, which makes it especially useful in understanding problems with joints and cartilage.
The goal of treatment, which requires surgery, is to prevent any additional slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited. Premature osteoarthritis could develop. Treatment should be immediate. In most cases, treatment begins within 24 to 48 hours. Early diagnosis of SCFE provides the best chance to achieve the treatment goal of stabilizing the hip.
Fixing the femoral head with pins or screws has been the treatment of choice for decades.
Depending on the severity of he child's condition, the surgeon will recommend one of three surgical options.
Reducing the displacement and placing one or two screws into the femoral head.
Removing the abnormal growth plate and inserting screws to aid in preventing any further displacement.
Placing a single screw into the thighbone and femoral epiphysis.
Your child may be restricted from certain sports and activities during this time of recuperation. This helps to minimize the chance of further complications. The fusion must be mature enough to prevent further slippage. Then, vigorous physical activities can begin.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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