Slipped Capital Femoral Epiphysis

Topic Overview

What is a slipped capital femoral epiphysis?

A slipped capital femoral epiphysis occurs when the upper end of the thigh bone (femur) slips at the area where the bone is growing (growth plate or physis) and does not fit in the hip socket correctly. The condition is most common in young teenagers. It's more common in boys than in girls.

What causes a slipped capital femoral epiphysis?

Rapid growth and an imbalance of hormones during adolescence may cause a slipped capital femoral epiphysis. An injury or a rapid increase in body weight or height may trigger symptoms.

What are the symptoms?

Symptoms usually begin between 10 and 16 years of age.¹ They may begin earlier in girls than in boys. Symptoms vary in severity and speed of progression. Symptoms may include:

• Hip tenderness and decreased movement during the early stages of the condition.
• Increased pain when the toes are turned in toward midline (internal rotation of the hip).
• Mild discomfort in the groin, thigh, or knee while walking or running. Rest relieves this discomfort.
• Knee pain. Sometimes knee pain is the first symptom.
• Stiffness and a limp, especially when tired.
• Muscle spasms.
• Mild to severe pain.

How is a slipped capital femoral epiphysis diagnosed?

Your health professional will conduct a medical history to learn how long you have had your symptoms and a physical examination to identify your symptoms. X-rays and sometimes CT scan or MRI are used to confirm a diagnosis of slipped capital femoral epiphysis.¹ Access to MRI scanners is not available in all areas. If you need an MRI scan, you may need to travel to a regional centre.

How is it treated?

The goal of treatment for a slipped capital femoral epiphysis is to prevent further slippage, restore the normal position of the bones, and reduce complications of the condition. This often involves surgery to secure the growth plate (physis) with a single screw or with pins. Osteotomy may be used in a severe case, but this is rare. In an osteotomy, the doctor cuts the bone at the top of the leg near the hip joint, moves the bone to a more normal position, then uses metal pins to hold it in place. The pins are usually left in the bone after it heals.

Crutches may be used to take weight off the hip. Before surgery this prevents further slippage and helps decrease pain. After surgery it decreases pain and helps keep the hip stable and in good position as it heals.

A slipped capital femoral epiphysis may lead to early degenerative arthritis of the hip if not detected early and treated properly.

Who is affected by a slipped capital femoral epiphysis?

A slipped capital femoral epiphysis is the most common serious hip condition seen in teenagers, more common in boys than in girls, and more common in very overweight teenagers. The condition most commonly affects young adolescents, ages 10 to 16 years old.

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Author:	Shannon Erstad, MBA/MPH Ralph Poore	Last Updated: February 25, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma Andrew Swan, MD, CCFP, FCFP - Family Medicine
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