While the name is certainly daunting, slipped capital femoral epiphysis (SCFE) is not difficult to understand. However, in order to better explain the condition, it is necessary to understand the hip joint.
Basics of the Hip Joint
The hip is a ball-and-socket joint; range of motion is possible because of ball-and-socket joints. In the hip joint, the rounded end of the thighbone, or femur, fits into the hollow cup-shaped end of the pelvis bone.
In children who are still growing, there is a growth plate known as the epiphysis that separates the top of the thighbone from the rest of the bone; it is located just under the ball portion of the hip joint. The epiphysis’s main function is to connect the femoral head, the rounded “ball” part of the bone, to the femur while still allowing the bone to lengthen and grow. The epiphysis is made of cartilage, which is weaker than bone. During periods of growth spurts in children, the increase in body weight and height can put extra pressure on the joints. It is during these growth spurts, just before puberty, that SCFE is most likely to occur.
Slipped capital femoral epiphysis is a separation of the ball of the hip joint from the rest of the thighbone; it occurs at the epiphysis, the growth plate located at upper end of the bone. Displacement may occur in one leg or it can affect both legs. With SCFE, an accurate and timely diagnosis with immediate treatment is critical in order to avoid complications. Patients may present with any of the following symptoms: difficulty in walking or walking with a limp; hip stiffness; pain while walking; knee or hip pain; an outward turning leg; or restricted and painful movements of the hip joint.
The causes for SCFE are not entirely clear. SCFE may result from a weakening in the growth plate, which can occur from trauma or inflammation or from changes in levels of hormones in the blood, which normally occur around puberty. At its worst, the separation can cause the top part of the thighbone to eventually lose its blood supply, decay, and collapse.
SCFE primarily affects children between the ages of 8 and 15 years old. SCFE occurs in nearly two of every 100,000 children. It commonly occurs in children during the periods of accelerated growth shortly after the onset of puberty. Typically, boys are affected more than girls. The condition seems to be more common in obese children. It can also develop in children with hormonal imbalances due to conditions such as thyroid dysfunctions, kidney disease, or growth hormone deficiency.
Other conditions that can increase the risk of developing SCFE include untreated infections of the hip joint, bone disorders, exposure of the pelvis to radiation or chemotherapy, or a patient taking certain medications such as steroids. A family history of SCFE is another risk factor for the condition.
Children suffering from sickle cell disease may have anemia due to a shortage of red blood cells. Anemia may lead to excessive fatigue and pain, which results from the tendency of abnormally shaped sickle cells to get stuck in blood vessels and block blood flow to parts of the body. Also known as crises, this pain is usually felt in the joints, long bones of the body, and the chest. It can last for up to a week.
An infant will not be diagnosed with sickle cell disease until he or she is four months old. The first sign of an infant with sickle cell disease is swelling of the hands and feet coupled with fever, swelling of the abdomen, and delayed growth. The child may also have jaundice (yellowing of skin and eyes) caused by the liver’s excessive breakdown of red blood cells. The spleen, an organ in the abdomen that fights infection, can get damaged by the breakdown of red blood cells. This will make it less effective in treating infections and can make the child more susceptible to diseases. If tiny blood vessels found in the eyes are blocked by sickle cells, the child can experience vision problems.
In the United States, sickle cell disease is commonly found in African Americans and people of Mediterranean (Turkish, Greek, and Italian), East Indian, or Middle Eastern origin.
The sickle cell gene can be inherited from the mother or father. If the child has one normal gene and one that carries the disease, the child is called a “carrier” for the sickle cell disease. There is a 50 percent chance of a child getting sickle cell disease if one of the parents has it and the other is a carrier. If both parents have only the trait and not the disease, the chance of getting sickle cell disease is 25 percent.
Misshapen sickle cells can cause damage to important organs when they get stuck in blood vessels. If blood that should reach the abdomen, chest, legs, and arms is blocked, severe “pain crisis” or “sickle cell crisis” can occur. Blockage of the spleen can increase the chance of infection, and blockage to the brain may result in stroke. Other complications associated with sickle cell disease include pulmonary hypertension (high blood pressure affecting the lungs), kidney and liver damage, blindness, gallstones (stones in gallbladder), and ulcers on the legs.
To detect sickle cell disease during the fetal stage, amniotic fluid, a liquid surrounding the baby in the womb, is tested for the sickle cell gene. Once the baby is born, it may be screened for hemoglobin S (a type of defective hemoglobin found in children with sickle cell anemia). This test is commonly performed on newborns by taking a blood sample obtained from the heel or finger of the infant. If the screening is positive, further tests can be carried out to check for sickle cell genes.
Children with sickle cell disease are highly prone to infections and are given antibiotics such as penicillin regularly until they are five years old. They may also be given folic acid to replace the damaged red blood cells in the body.
For pain relief, the doctor may prescribe over-the-counter medication and heat application to the painful area. A medication known as hydroxyurea can be prescribed to stimulate fetal hemoglobin that prevents the formation of sickle cells.
In severe cases, the red blood cells are taken from donor blood and intravenously supplied to the patient. This increases the red blood cell count and helps reduce anemia and the risk of lethal brain stroke in children. A bone marrow transplant may also be taken from a healthy donor if patients have bones damaged by sickle cell disease.
Calling Your Doctor
Call your doctor if your child exhibits the following symptoms: