Slipped capital femoral epiphysis

Definition

A slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) of the bone.

Alternative Names

Femoral epiphysis - slipped

Causes, incidence, and risk factors

A slipped capital femoral epiphysis may affect both hips.

An epiphysis is an area at the end of a long bone that is separated from the main part of the bone by the physeal plate (growth plate). In this condition, a displacement occurs in the upper epiphysis while the bone is still growing.

Slipped capital femoral epiphysis occurs in about 2 out of every 100,000 children. It is more common in growing children ages 11 to 15, especially boys, It is also more common in children who are obese, and in children who are growing rapidly. Children with hormone imbalances caused by other conditions are at particular risk for this disorder.

Symptoms

• Difficulty walking, walking with a limp
• Knee pain
• Hip pain
• Hip stiffness
• Outward-turning leg
• Restricted hip movements

Signs and tests

During a physical examination, the doctor will look for restricted hip motion and pain with attempted hip movement. A hip or pelvis x-ray shows displacement.

Treatment

Surgery to stabilize the bone with pins or screws will prevent further slippage or displacement of the ball of the hip joint. Some surgeons may suggest using pins on the unaffected hip at the same time, because many children will develop a slip in that hip as well.

Support Groups

Expectations (prognosis)

The outcome is usually good with treatment. However, in rare cases, the hip joint may wear away, despite prompt diagnosis and treatment.

Complications

This disorder is associated with a greater risk of osteoarthritis later in life. Other potential but rare complications include reduced blood flow to the hip joint and wearing away of hip joint tissue.

Calling your health care provider

If your child has persistent pain or other symptoms of this disorder, have the child lie down immediately and remain still until medical help is obtained.

Prevention

Weight control for obese children may be helpful. Many cases are not preventable.

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References

Hosalkar HS, Horn D, Friedman JE, Dormans JP. The hip. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 677.