If your child is experiencing hip pain, limping, or difficulty walking, it could be a sign of Slipped Capital Femoral Epiphysis (SCFE). This hip condition is typically common among growing adolescents and may require prompt medical attention to prevent serious complications. Our Senior Consultant Orthopaedic Surgeon can assess and manage SCFE in adolescents.
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SCFE is a hip disorder in adolescents in which the ball of the thighbone (femoral head) slips backward and downward relative to the neck of the thighbone at the growth plate. This condition usually affects children aged 10–16 during growth spurts.
In stable SCFE, the patient can still bear weight on the affected leg, either with or without crutches. The femoral head remains relatively aligned despite the slip.
In unstable SCFE, the patient is unable to bear weight on the affected leg, even with crutches. The femoral head has displaced more compared to stable SCFE. This type requires urgent medical evaluation.
SCFE can also be classified by duration.
The exact cause of SCFE is not fully understood. It occurs when the growth plate (physis) in the hip is weakened during adolescence. Rapid growth periods may make the growth plate more vulnerable to shearing forces. Hormonal changes during puberty can affect growth plate strength, and mechanical stress from body weight and activity may increase strain on this area.
Symptoms typically develop gradually in chronic SCFE over weeks to months. In acute SCFE, severe symptoms appear suddenly, often after minor trauma or a fall.
Schedule a consultation with our Senior Consultant Orthopaedic Surgeon for an accurate diagnosis and personalised treatment plan.
Medical evaluation is recommended if an adolescent experiences sudden hip pain and difficulty bearing weight, which may indicate unstable SCFE. A consultation is advised if limping, hip or knee pain persists for more than a week, or if there are difficulties with normal activities such as walking or climbing stairs.
During the consultation, our orthopaedic surgeon may perform a physical examination, review medical history, and order imaging studies. The examination may include assessing gait, measuring leg lengths, and testing hip range of motion. Bringing any previous X-rays or medical records related to hip problems can be helpful.
Timely evaluation can help healthcare providers determine the appropriate management of SCFE and reduce the risk of further slippage or complications, including avascular necrosis.
Conservative treatment is extremely limited in SCFE and typically only involves non-weight bearing with crutches while awaiting surgery. Bed rest may be prescribed for unstable SCFE to prevent further slippage before emergency surgery. Physiotherapy is not recommended before surgical stabilisation as it may worsen the slip.
This minimally invasive procedure involves placing a single screw through the femoral neck into the head to prevent further slippage. The surgery is performed through a small incision using fluoroscopic guidance. This procedure is commonly used for stable SCFE with mild to moderate slips. Recovery involves 6-8 weeks of protected weight bearing.
For unstable SCFE, gentle reduction may be attempted to improve femoral head position before fixation. This must be performed carefully to minimise risk of avascular necrosis. The reduction is done closed (without opening the joint) under anaesthesia, followed by screw fixation.
Severe SCFE with significant deformity may require complex reconstructive surgery. Options include proximal femoral osteotomy to correct alignment, Dunn procedure for severe slips, or hip arthroscopy to address impingement. These procedures carry higher risks but may be considered to address deformity or complications.
Pinning the unaffected hip remains controversial. It may be considered in high-risk patients including those with endocrine disorders, very young age at presentation, or severe obesity. The decision requires careful discussion of risks versus benefits.
Following surgery, patients undergo structured rehabilitation. Initial phase focuses on protected weight bearing with crutches. Progressive strengthening begins after 6-8 weeks. Return to sports typically occurs at 3-6 months, depending on the procedure performed and healing progress.
Our Senior Consultant Orthopaedic Surgeon will assess your specific situation and recommend the most suitable treatment approach for you.
Untreated SCFE can progress and may result in hip deformity and dysfunction. Avascular necrosis (death of bone tissue) can occur in unstable SCFE, which can result in collapse of the femoral head. In some cases, hip replacement may be considered.
Chondrolysis, or cartilage loss, can develop even with treatment but is more common in delayed cases. It may cause joint stiffness and pain. Femoroacetabular impingement results from altered hip anatomy, which may contribute to labral tears and early arthritis.
Long-term complications may include osteoarthritis developing in adulthood. Leg length differences may require shoe lifts or additional surgery. Chronic hip pain and limited mobility may affect daily activities.
While SCFE cannot always be prevented, certain measures may reduce risk. Maintaining a healthy body weight through balanced nutrition and regular physical activity is important. Overweight adolescents may work with healthcare providers on safe weight management strategies.
Early recognition of warning signs allows timely evaluation before further slippage occurs. Parents should monitor for hip or knee pain during growth spurts. Regular check-ups can help identify at-risk children, particularly those with endocrine disorders.
For children with SCFE in one hip, close monitoring of the opposite hip is recommended. Prophylactic pinning may be considered for some patients to reduce the risk of bilateral SCFE. Activity modification during treatment and recovery may help reduce further slippage.
Most children can return to sports activities after successful treatment and rehabilitation. The timeline varies depending on the severity of SCFE and type of surgery performed. Low-impact activities can resume at 3-4 months, while contact sports may require 6 months or longer. Our orthopaedic surgeon can provide specific guidelines based on your child’s healing progress and the demands of their chosen sports.
Risk factors for bilateral involvement include younger age at presentation, endocrine disorders, and severe obesity. Regular monitoring with X-rays is essential, and some high-risk patients may benefit from prophylactic pinning of the unaffected hip.
The duration of crutch use depends on the type of surgery and surgeon’s protocol. For stable SCFE treated with in situ pinning, partial weight bearing with crutches typically continues for 6-8 weeks. Unstable SCFE may require a longer period of protected weight bearing. Our orthopaedic surgeon can provide specific instructions and monitor progress through follow-up appointments.
SCFE can affect growth and cause leg length discrepancy, particularly in severe cases. Early treatment may reduce these risks. Minor discrepancies (less than 2cm) rarely require intervention. Significant differences may need shoe lifts or, rarely, leg lengthening procedures. Regular monitoring during remaining growth years helps identify and address any developing discrepancy.
Warning signs of complications include increasing hip pain despite treatment, sudden onset of severe pain (suggesting avascular necrosis), progressive stiffness, or inability to bear weight. Fever, warmth, or drainage from the surgical site may indicate infection. Any of these symptoms require immediate medical evaluation to prevent permanent damage.
While SCFE is not directly inherited, there is a familial tendency. This suggests genetic factors may influence growth plate strength or hormonal factors. Families with one affected child should be vigilant about monitoring other children during adolescent growth spurts.
In situ pinning for stable SCFE generally has good outcomes. Unstable SCFE has more variable outcomes due to higher complication risks. Follow-up care focuses on monitoring hip joint alignment and healing.
SCFE is a hip condition that occurs in adolescents. Early detection may allow treatment when the slip is mild and stable. Our Senior Consultant Orthopaedic Surgeon has experience with current surgical techniques to provide optimal care for young patients with SCFE. Surgical and non-surgical management options are available depending on the severity and type of SCFE. Following appropriate treatment and rehabilitation, children may gradually resume normal activities under medical guidance.
Living with SCFE can be challenging. Our Senior Consultant Orthopaedic Surgeon has experience diagnosing and treating SCFE using evidence-based approaches.
A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.
Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.
His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.
Our friendly clinical staff will assist you with your registration, ensuring an efficient and hassle-free process for you.
During your consultation, we will evaluate your medical history and the pain you are experiencing. You may also ask questions about your condition.
We will likely perform some form of diagnostic imaging (e.g. X-Rays, MRI) to assess your condition accurately.
After imaging, we will review the results of your scans thoroughly, and advise an individualised treatment plan for you.
As you go through your treatment plan, we will follow up with you every step of the way, ensuring that you receive the dedicated care you deserve.
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38 Irrawaddy Road, #05-36, Singapore 329563
Parkway East Medical Centre
319 Joo Chiat Place, #03-06, Singapore 427989