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Treatment for Slipped Capital Femoral Epiphysis
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Posted on: 11/30/1999
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Some adolescents, teens, develop a hip disorder called slipped capital femoral epiphysis (SCFE). It's one of the most common hip disorders in this age group affecting between two and 10 out of every 100,000 people in the United States.
Doctors aren't sure what causes the problem. The ball at the top of the thigh bone (the femur) slips backwards, usually during so-called growth spurts, such as just after puberty starts. Unstable SCFE is diagnosed when the disorder makes it too difficult for the patient to walk, even with crutches. Unfortunately, patients with the unstable SCFE have a high rate (47 percent) of developing osteonecrosis, or bone death. This doesn't happen when it's stable.
Treatment for SCFE is to stabilize the area and prevent further movement and damage, but the best way to do this still isn't known. One method, called in situ fixation - In situ means in place. In article written by Loder and colleagues, recommended that doctors try closed reduction (putting it back into place without surgery), decompression, or using screws to stabilize the hip. After this surgery, the patients need to keep weight off the hip, using crutches for at least six to eight weeks.
Spontaneous reduction is a reduction that happens by chance. For quite a while, intentional reduction of SCFE wasn't done because of the reported high risk of osteoporosis so it it's not encouraged. Unintentional spontaneous reduction can happen when the patient is under anesthetic.
One suggested treatment is called modified surgical hip dislocation, and doctors use this to treat two complications that can arise from SCFE: the osteonecrosis and deformity. The surgery involves shortening the neck of the femur and removing the thickening, or callused area. Although there haven't been any large studies or series of studies to show the procedure's effectiveness, smaller studies have found that it is a successful treatment.
When to treat SCFE is also a question. If it's an unstable case, the hip should be stabilized within 24 hours of the first symptoms if possible. If the patient isn't seen within that 24 hours, usually doctors wait for about a week before treating.
The authors of this article concluded that the population affected by SCFE is changing. Doctors are finding it more often in younger children and among more girls than boys. What hasn't changed is that many of the children affected are also obese. Treatments have changed too. While intentional reduction was once avoided, it is now being done more often, but will have to be studied further to identify the pros and cons of the procedure.
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References:
Lauren A. Allen and Daniel J. Sucato. Unstable Slipped Capital Femoral Epiphysis. In Current Orthopaedic Practice. April 2009. Vol. 20. No. 2. Pp. 175-179.
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