What it means?
Slipped capital femoral epiphysis means the top part of the femoral thigh bone which connect with the socket of the hip joint slips through the growth plate. This can happen slowly over a period of time or suddenly.
What causes it?
The exact cause of the condition is not known. Most of the children with overweight, endocrine pathology have increased risk for upper part of femoral head (capital femoral epiphysis) to slip at the growth plate level. As a result of this slip, it starts to heal in that abnormal position and gives deformed shape to upper end of thigh bone (femur) which connect with the socket (acetabulum) of the hip joint. Thus causes pain in hip, movement restriction and outward foot pointing walk pattern on the affected side.
How child will present like?
- Most commonly seen in the children around the adolescent age group between 11 to 14 years of age
- More common among obese children can happen in slim children too
- Child who is on growth hormone treatment, kidney or thyroid problems are at greater risk of developing slip
- Child usually present with complains of pain in the hip or groin, some times may have pain in their thigh or knee
- Child may not be able to walk or bear weight over the affected limb in case of Acute unstable slip
- Child will be able to walk with limp and pain in case of chronic stable slip
- Child may walk with the affected leg turned outwards
- If child develops slip on one side of hip, 1 in 4 children have chance to develop slip on the other side
What are the tests required?
- Child need to be checked clinically for his/ her hip range of movements, any discomfort in the hip joint, limb length difference, walking pattern
- Child limb rotates outwards on an attempt to flex the hip that is Obligatory external rotation and there will be asymmetric limitation of internal rotation of hip on the affected side
- X-ray of both the hip joint helps to assess the status of femoral head, degree of slip of femoral capital epiphysis, to plan the further management.
What are the treatment options?
- The treatment for slipped capital femoral epiphysis is surgery only. The type of surgery varies according to the degree of slip, duration of the slip
- In case of mild slip, the slipped upper part is held in position with one or two screws in order to prevent further slippage
- In moderate to severe slips, the upper part of femur will be deformed more, in such situation we need to open the hip joint safely without affecting its blood supply and slip is corrected and fixed with one or two screws, excess new bone formed which cause restriction to hip range of movement were also trimmed during the same procedure in order to facilitate better hip movements
What will be outcome?
- The outcome depends upon the severity of slip and duration of the slip
- In stable slip and treated at the earliest, most of the children will have good outcome and able to return to sports and their routine activites
- In case of unstable slip and delay in presentation, there is more risk of loss of blood supply to the ball (femoral head) of the hip joint which can lead to deformity, pain if not treated by appropriate surgery will have increased risk of developing hip impingement and arthritis in the future