DDH | Perthes Disease | FEMORAL OSTEOTOMY | PELVIC OSTEOTOMY
Slipped Capital (or upper) Femoral Epiphysis is a condition that affects children and adolescents usually between the ages of 10 and 15. The cause is unknown but it is thought to occur due to a weakness in the upper femoral growth plate at a stage of rapid growth.
It is more common in boys than girls. The disease presents with a limp and pain. The pain can be in the hip or can be referred to the thigh or knee. The diagnosis is often delayed because the pain may only be in these other areas. The leg often turns out as this condition progresses. In any child around this age group who presents with a limp and hip, thigh or knee pain, SCFE must be excluded.
Xrays may be deceptive in the early stages. There is a condition called pre-slip where even though there is pain, the plain xrays may be normal. MRI (or Bone scanning) may be required to make the diagnosis.
SCFE may be stable or unstable. In stable slips, the child is able to walk. With unstable slips, the child can only walk with a lot of pain or requires crutches. These can be rapidly progressive and require urgent management.
Treatment is surgical stabilisation of the SCFE. In mild to moderate slips, the treatment is pinning the hip in situ. The management of severe slips, or unstable slips depends on the treating surgeon. It is extremely important to have your child seen urgently in this situation. The treatment is tending toward early surgical hip dislocation, reduction and fixation in this severe group. The main potential complication with unstable slips is AVN (avascular necrosis) where the head of the femur loses it’s blood supply. In this situation, the head of the femur can collapse and the hip can become arthritic. Management of the hip can then be extremely difficult and may eventually require Joint Replacement.