Chapter 89: Slipped Capital Femoral Epiphysis (Scfe)

Patient Story

A 10-year-old male presents to your office with a 1-month history of left groin pain and intermittent left medial thigh pain as well. His symptoms are typically worse with activity, and his parents have noted that he limps. His parents relate that he has had a similar problems in the past. An x-ray of the left hip shows a slipped capital femoral epiphysis (Figures 89-1 and 89-2). The patient is made non-weight bearing, he is immediately admitted to the hospital and Pediatric Orthopedics is consulted for surgical management.

Introduction

Slipped capital femoral epiphysis (SCFE) is a relatively common disorder of the adolescent hip. “Skiffy” for short, SCFE is failure of the proximal femoral physis during periods of accelerated growth. This failure results in discontinuity arising between the head and neck of the femur. The femoral head stays located in the acetabulum, while the femoral neck migrates superiorly and anteriorly.

Synonyms

Slipped upper femoral epiphysis (SUFE).

Epidemiology

• SCFE most commonly occurs in adolescent boys between the ages of 10 and 16 years. It occasionally occurs in girls as well—usually between the ages of 12 and 14 years—but girls are half as likely as boys to have slips.¹

• Annual incidence is estimated at 8.3 unilateral cases and 0.5 bilateral cases per 100,000 children.²

• Slips are more common in obese children³ and they occur 2 to 4 times more frequently in black and Hispanic children than in white children.^1,4

• The left hip is involved twice as frequently as the right hip. Bilateral slips occur 20 percent of the time,¹ usually within 12 to 18 months of the first slip.

• Interestingly, SCFE tends to show seasonal and regional variability. Slips tend to occur more frequently in warm months⁵, and there is a predilection for slips to occur more frequently in the Northeastern and Western US.¹

Etiology and Pathophysiology

• Etiological factors for SCFE are thought to be numerous. They include local trauma, mechanical factors (physeal weakness during puberty, stress from obesity),^6,11 endocrine disorders (hypothyroidism, pituitary deficiency),¹ inflammatory conditions, and genetic factors.

• All proposed etiological factors ...