Something we at McKeen & Associates have witnessed is the inadequate care of SCFE (Slipped capital femoral epiphysis). SCFE is a very common hip disorder in adolescents.
A growth plate (physis) is found between the femur head (epiphysis) and the neck of the femur, which creates a space between the femur head and femur. SCFE occurs when the ball at the head of the femur slips off the neck of the femur. It is not the result of trauma, but is likened to ice cream slipping of a cone.
There are two types of SCFE, stable and unstable. Most are stable, which means the patient is able to walk or bear weight on the affected hip (with or without crutches) and usually has much better outcomes. Symptoms include intermittent pain in the groin, hip, knee and/or thigh that usually worsens with activity.
An unstable SCFE is when the patient cannot walk or bear weight, even with crutches and symptoms include sudden onset – often after a fall – and outward turning of the affected leg. There are significant complications associated with unstable SCFEs.
Both stable and unstable SCFEs are treated with a metal screw across the growth plate to maintain the position of the femoral head, growth plate and femur. The screw stabilizes the anatomy and prevents further slippage; over time, the growth plate with fuse or close. Until the growth plate has completely closed, slippage remains a risk.
After screw fixation, the patient will follow up with the physician, who will take x-rays at each visit to ensure the growth plate has completely closed and that the screw remains in the right place. Once it is closed, no further slippage can occur.
Early diagnosis and timely, adequate surgical stabilization is essential for a good outcome for SFEC. In situ fixation with one screw is standard treatment. Given the risk of slippage, the fixation of the slipped epiphysis of the hip can only be removed after the growth plate has closed completely. Most physicians do not remove the hardware even after the growth plate has fused unless there are complications arising from the screw itself. Removal of the screw requires a second surgery, which can be expensive, and carries the slight risk due to the need for anesthesia. The hole left when the screw is removed also increases the risk of fracture once taken out. If the screw is removed, the surgeon may recommend crutches for three to six weeks afterward.
When it is confirmed that the plate has fused, follow up physician visits will be focused on whether the abnormality is likely to require additional surgery to realign the hip.