The risk of this condition is higher among kids who are overweight, and also among boys. Many times, diagnosis is delayed because pain is referred to the knee or thigh (as in my patient). As time goes on, the femoral head slips more and more, like a scoop of ice cream slowly slipping off the cone on a hot day.
So began our journey with SCFE. A SCFE is when the ball slips off of the femoral neck like the ice cream slipping off of a cone. Doctors don't know why it happens but it occurs in 1 out of every 100,000 kids.
After mentioning S.C.F.E. to Jeremy he sent us on to a sports medicine theropiist within the hour. Tony Cox checked Zak's gate, talked to him, and measured his legs. His right leg, the sore one, was one inch shorter. He immediately went up stairs to Dr. Matthews, an orthopedic surgeon, and had us in front of him within an hour! Dr. Matthews x-rayed and diagnosed him with SCFE.
Another condition that has impacted a growing number of children is SCFE or Slipped Capital Femoral Epiphysis. In this condition a weakened growth plate causes the upper end of the femur (thigh bone) to slip backward in the hip joint. Although the incidence for SCFE is 10.8 cases per 100,000 children, the rate is higher among obese children.
As Danielle was getting off of the school bus, I noticed she was noticeably limping on her right side. I thought that she may have twisted her ankle at school; perhaps in PE class or running around school.
Slipped Capital Femoral Epiphysis (SCFE) is the most common hip pathology in adolescents, it involves displacement at the epiphyseal plate (growth plate) involving the epiphysis and metaphysis.
A SCFE occurs when a weak spot in the growth plate causes the "ball" portion of the hip to slip out of position. The name "slipped capital femoral epiphysis" is a misnomer because the femoral head (aka "capital femoral epiphysis") actually stays in within the hip socket while the femoral neck "slips" forward (aka anterior) and rotates outward (aka external rotation). A SCFE is not a crack in the bone, but more like a crack in the growth plate.
Slipped capital femoral epiphysis (SCFE) is a disorder where the femoral epiphysis displaces from the femoral neck through the physeal plate. It is a common hip disorder in adolescents affecting approximately 10 per 100,000. Note however, about 15% will present with no description of hip pain but rather knee or thigh discomfort. Thus it is important to maintain a high degree of suspicion to diagnose and treat early.
Symptoms ◦groin and thigh pain ◾most common presentation
◦knee pain ◾can frequently present as knee pain (15-23%)
◦motion ◾patients prefer to sit in a chair with affected leg crossed over the other
◦duration ◾symptoms are usually present for weeks to several months before diagnosis is made.
Most patients complain of pain in the groin or hip, but some patients complain of pain in their thigh or knee. The patient may not be able to walk or may walk with a limp. Sometimes the patient may walk with the affected leg turned outward. Many kids have been told they have growing pains or a muscle pull because of the thigh and knee pain.
SCFE usually occurs in early adolescence and preferentially affects boys. Obesity is a significant risk factor. Genetic factors also contribute. SCFE is bilateral in one fifth of patients, and unilateral SCFE becomes bilateral in up to two thirds of patients.
Often atraumatic or associated with a minor injury, slipped capital femoral epiphysis (SCFE) - also known as slipped upper femoral epiphysis - is one of the most common adolescent hip disorders and represents a unique type of instability of the proximal femoral growth plate.
osteonecrosis of femoral head; increased risk with high grade slip