What is Slipped Capital Femoral Epiphysis

Having a slipped capital femoral epiphysis means that the top of the thigh bone (femur) has moved out of its place in the hip socket. This often happens during a time of fast growth, such as childhood or adolescence.

During this time, the top of the femur is made of tissue (cartilage) that develops into bone with age. This portion of cartilage is called the epiphysis, or growth plate. The epiphysis is weaker than bone, and it is more likely to slip out of the hip socket.

When treated properly, this condition almost always heals and normal leg and hip function is restored.

What are the causes?

This condition may be caused by:

• Growing very quickly in a short period of time (growth spurt).
• An injury, such as a fall.

What increases the risk?

This condition is more likely to develop in:

• Children who are 8–15 years old.
• Men.
• People who are overweight or obese.

What are the signs or symptoms?

The main symptom of this condition is pain in the injured leg, especially in the thigh and knee. Your child may also have pain in the hip joint. Other symptoms may include:

• Pain that gets worse when your child moves the leg or uses the leg to support (bear) his or her weight.
• Inability to bear weight on the leg.
• Limping.
• Having an injured leg that:
  • Turns outward, away from the other leg.
  • Seems shorter than the other leg.

How is this diagnosed?

This condition is diagnosed based on your child’s symptoms, medical history, and a physical exam. Your health care provider may ask your child to walk or move the injured leg. Your child may have tests, including:

• X-rays.
• Ultrasound. This uses sound waves to create a picture of the leg.
• MRI.

How is this treated?

This condition is usually treated with surgery. Your child’s health care provider may recommend medicines to help reduce pain and inflammation.

Surgery usually includes using pins or screws to prevent this condition from happening again. Options include:

• Putting a screw in the top of the femur. This holds it in the hip socket.
• Moving the top of the femur back into the hip socket, then using two screws to hold it in place.

After surgery, your child will need to use crutches for walking (partial weight-bearing) for as long as told by his or her health care provider. Your child may need to have X-rays regularly for the next 1–2 years to monitor the epiphysis. Your child’s health care provider may refer your child to a physical therapist. This specialist can help your child to strengthen and stretch the injured area after surgery.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Have your child raise (elevate) the injured area above the level of his or her heart while he or she is sitting or lying down.

Activity

• Do not allow your child to use the injured limb to support his or her body weight until your child’s health care provider says that it is okay. Have your child use crutches as told by his or her health care provider.
• Have your child rest his or her hip and leg as much as possible until he or she feels better.
• Have your child return to normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe for your child.
• Have your child do exercises as told by his or her health care provider or physical therapist.

General instructions

• Give over-the-counter and prescription medicines only as told by your health care provider.
• Do not allow your child to drive or operate heavy machinery while taking prescription pain medicine, if this applies.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has pain that gets worse or does not improve with medicine.
• Your child has a fever.
• Your child has redness or swelling around the injured area.
• Your child has tingling or a “pins-and-needles” feeling in the leg.

Get help right away if:

• Your child feels numb in any part of the hip, leg, or foot.
• Your child’s leg or foot turns gray or blue.
• Your child has severe pain.