Slipped capital femoral epiphysis treatment
Slipped capital femoral epiphysis, which is a slippage of the thighbone from the hip socket, is unusual but not rare. The treatment and surgery for a slipped capital femoral epiphysis depends on a number of factors, including a child’s age, past and present health, severity of the injury and history with other medications and treatments.
A slipped capital femoral epiphysis can make walking difficult and will worsen over time if not treated. If you have any reason to suspect that your child has this injury, it is important to seek medical attention. To diagnose your child, the doctor will talk to you and your child about recent trauma (if any) and perform a physical exam. To further determine the right diagnosis and treatment method, the doctor may perform one of the following tests:
- X-ray (radiograph) – This is usually the first and only imaging test performed. It shows the bone structure on an image transposed in black and white, which exposes the location of the fracture. Radiation passes through your child’s body and is used to produce images of the pelvis and thighbone to look for any abnormalities, slippage or fractures. Bone stands out in a radiograph because it absorbs the radiation.
- Magnetic resonance imaging (MRI) – In some cases, an X-ray may not show the slippage clearly, so a doctor will order an MRI. This test is performed by placing the child in a vessel that, through vibrations caused by magnets, displays a high-definition computer image.
It is rare that a child will not require surgery for this condition. This is because there are risks involved with letting the injury repair itself, such as further slippage which can lead to blood loss and complications. In all cases, the child will be put on bed rest immediately and be advised not to apply any weight to the side where the slippage occurred. However, in some mild cases, traditional methods of fracture repair may be used, such as casting the bone.
In nearly every case a slipped capital femoral epiphysis necessitates surgery. Studies have shown that trying to allow the bone to repair naturally can lead to further complications, so surgery is the best method for repair. The goal of the surgery is to prevent any further slippage. Depending on the severity of the injury, the following techniques may be used:
- In-situ fixation – The slippage is stopped by screwing the bone into the area where the slippage occurred. If the slippage is minor or caught early, it often can be stopped by placing a single screw in the femoral head and through the growth plate.
- In-situ fixation with multiple screws – If the slippage is more than moderate, more than one screw may be needed to hold the slipping femoral head in place.
- Removing the abnormal growth plate – When the growth plate has been damaged beyond repair, it may need to be removed to prevent further complications.
- In-situ fixation on the healthy hip – While surgery on a healthy bone is not usually advised, it is often recommended in cases with a high likelihood that the other hip will also slip over time.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs slipped capital femoral epiphysis surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.