SCFE/ SUFE – Slipped Epiphysis
Slipped Capital Femoral Epiphysis (SCFE) or Slipped Upper Femoral Epiphysis (SUFE) relates to the slipping of the neck of the femur (thighbone) within the socket (acetabulum). SCFE is a condition that appears to be on the increase in the UK and worldwide. It has been linked to childhood obesity and is more common in boys than girls.
The cause is unknown. It usually happens between the ages of 8 and 17 years.
Symptoms and Diagnosis
Symptoms of SUFE can be easy to miss and this can result in a delay with diagnosis. Sometimes the foot can appear rotated outwards, that is painful to move into a more normal position. There may be pain in either the hip or the knee that appears gradually, over a couple of months (gradual slip) or suddenly (acute slip). The pain will limit movement and cause a limp.
SUFE can be classified relating to its stability or the ability to tolerate weight on the affected side and its severity. Risks of the condition, such as avascular necrosis (breaking down of the bone structure), increase with the severity of the original condition.
Usually X-rays of the hip will be done to confirm the problem and give an idea of how bad the slip is.
An operation will be needed to stabilise the growth plate and to stop it slipping more. Your child will need to be on bed rest and may have skin traction to both legs for about one week. They will be given medication for pain relief.
A mild to moderate slip can be treated with a surgical screw, inserted across the growth plate to secure the head of the femur. A few days of bed rest is usually followed by use of crutches to walk. A more severe slip requires a more individual approach and will be discussed with the treating team and the family.
Steps have produced a factsheet on SCFE for families affected by the condition. Steps have also produced a guide to help parents and carers prepare themselves and their child for a hospital admission.
The BOSS study (British Orthopaedic surgery surveillance study) is a nationwide reporting mechanism to determine the extent and outcomes in rare orthopaedic diseases. The idea is to gather information on different groups of patients starting with Perthes and SUFE to help treatment success in the future.
A Mum’s SUFE story
My son Ryan was 13 years old and very active. He enjoyed playing football for his local team and running around with his mates. He was just a normal teenage boy. He started to complain of muscle pain in his left thigh which we put down to growing pains at first. The pain gradually got worse over the next weeks so we took him to the GP who diagnosed a pulled muscle and Ryan was told to rest.
Within a month Ryan started to have trouble turning his leg inwards and when he was relaxed his leg would turn outwards naturally, we took him back to our GP who still thought it was a pulled muscle from football. After 3 months of pain and now unable to walk up the stairs he was sent for an x-ray of his hips by our GP, but the x-ray came back clear.
Ryan continued to get worse and at this stage he couldn’t physically lift his leg. We were distraught at what we were seeing, not knowing what was going on and at one point our GP asked if Ryan was being bullied at school as he thought this may be the reason for him wanting to avoid school. Of course, this wasn’t the case.
After around 4 months and numerous trips to our GP Ryan was sent to A&E where we saw a specialist who just by Ryan’s walk he knew what was wrong. He sent Ryan for an x-ray but requested a frog position, and when the results came through we were told it was a S.U.F.E, the previous x-ray had missed it as it was a front view of the hips.
We were so relieved but scared at the same time, we had never heard of this and didn’t have any clue of the treatment outcome etc. Ryan was kept in hospital and we told that he would need an operation the following morning where his leg would be pinned into place and made stable.
Ryan was nervous and scared but we reassured him it would be OK. The operation didn’t take too long and Ryan was soon back with us. He was very sore in the hip area but otherwise fine. When we spoke to the Dr afterwards, he explained that the head of the femur was misshapen from the rubbing of the bones where the leg had slipped and he had been walking round. The leg was in place but not in an ideal position due to this. We were given instructions that Ryan was non-weight bearing for 6 weeks and would need physio.
Trying to keep a 13-yr. old from being active was very hard once he had started to heal but we got there and at his 6-week check-up things were looking really good. We were told he will probably get arthritis at an early age in the hip and may need a hip replacement a lot younger than normal due to the wear on his hip. As Ryan grew the screw began to rub and he had it removed which made a significant difference to his daily life as it caused him pain.
Ryan hasn’t let it affect him. He started to play rugby and was very good at it, he knew his limitations and stuck to them. Ryan has kept very active which I think has help him a lot, at 16 he joined Cardiff city sports college where his team made history by going up a league. He is 18 now and going to university in September to do a sports degree and hopefully become a sports coach. Ryan still has some pain in his groin area especially if it’s been a hard day in college as its all physical activity and in the mornings, he takes while for the hip to ease as it feels stiff, but overall, he has made an amazing recovery and has shown that SUFE doesn’t stop you achieving your dreams.
The picture is Ryan in his football team when they won the league. I am very proud of what he has overcome.