Slipped Capital Femoral Epiphysis (SCFE) for the Orthopedic Patient
Important information:
Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects children and adolescents. In SCFE, the head or "ball," of the thigh bone slips off the neck (top) of the thigh bone. An analogy (or comparison) commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. This condition causes the hip joint to become painful and stiff. The condition is more common in boys, and in overweight patients.
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SCFE can occur from a minor trauma, twist, or fall, but it may also develop over time. It often occurs in children who are growing rapidly or overweight. It can also be related to hormonal changes in the body or an underlying metabolic disorder. It is diagnosed by a pelvis X-ray.
Signs and symptoms
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Hip, thigh, groin or knee pain
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Difficulty walking or developing a limp
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A new change in how your child walks
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Change in hip range of motion or stiffness in the hip joint
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Lower extremity often turns out when standing or walking
Patient instructions:
This is an emergency. Immediately stop walking on the affected side. Use crutches, walker, or wheelchair. Go to the emergency room. The goal is to prevent further slippage.
Surgical treatment is required for a SCFE:
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Surgery involves placing a screw through the growth plate in the thigh (femur). This screw keeps the top of the femur bone from slipping further and will close the growth plate. This is done through a small incision at the top of the thigh.
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Sometimes the surgeon will discuss pinning both hips even if only one side developed the slip.
Hospital care after surgery will include:
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Your child will stay in the hospital for 1-2 days.
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Intravenous (IV) pain medicine as needed, until pain is well controlled with medicine taken by mouth.
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Progress to regular diet as tolerated.
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Physical therapy for crutch or walker training.
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Weight-bearing will be determined by your orthopedic surgeon. The timeline for return to weight bearing is different for each patient.
Care at home
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Your child will go home with pain medicine. As their pain improves, they should use less narcotic pain medicine, then use none at all.
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For mild pain use acetaminophen (Tylenol®) or ibuprofen (Advil®). Follow the dosing instructions on the label.
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Use crutches, walker, and wheelchair as instructed.
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Follow the instructions given by your care team regarding when it is safe to shower and to get the surgical incision wet.
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Small dressings will remain in place for 3-5 days. After 5 days remove the dressing. Steri-Strips™ (paper tape) will fall off on their own.
Return to school
Your child may return to school when:
Arrange the following with the school:
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The use of crutches or a walker
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Extra time between classes to avoid crowded hallways
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If your child uses crutches, another child needs to carry his books
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No gym, sports, running, jumping, or any activities that could cause a fall
If the school cannot accommodate any of the above, your orthopedic team can help you request home schooling. Call 215-590-1257 or fax a form from the school to 215-590-1501.
Follow-up appointment
Your surgeon will let you know when your child should return to clinic. Call 215-590-1527 to schedule the appointment.
Call your CHOP orthopedic team with question, concerns or if your child has:
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Fever greater than 101.5°F (38.3°C)
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Pain that is not relieved by pain medicine
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Drainage from the incision
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Signs of a wound infection: redness, swelling, fever, pus or foul-smelling odor from the incision
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Change in sensation of the leg (numbness, tingling, cool to touch)
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Pain in the opposite leg (if it has not been pinned)
Weekdays:
215-590-1527
Nights, weekends, and holidays:
Call 215-590-1000 and ask the operator to page the orthopedic resident on call.
Reviewed March 2024 by Alison Lehman, PA-C