Slipped Capital Femoral Epiphysis

It is a problem that occurs at the end of the thigh bone that forms the hip joint, mostly in young adulthood. It is more common in men. It occurs when the femoral head and thigh bone slip/fracture from the growth plate region. Although it is originally a rupture of the growth plate, most of the time there is no serious underlying trauma. After this slippage, the femoral head remains in the pelvic socket, while the other part of the thigh bone is displaced.

It is not clear why FBEK occurs. Many factors are thought to weaken the growth plate at the tip of the femur and increase the fragility of this region. Obesity is one of these factors. The prevalence of childhood obesity has increased in recent years. Parallel to this increase, the number of FBEKs also increases. In addition, some endocrinological diseases (thyroid gland diseases, growth hormone therapy, renal osteodystrophy) may be associated with FBEC.

Patients usually apply to the doctor with the complaint of pain radiating to the front of the hip, thigh or knee. It is seen that many patients only have pain radiating to the front of the knee and the diagnosis is delayed in these patients. These children are evaluated by different doctors for knee pain; X-ray and magnetic resonance imaging (MRI) of the knee are obtained and there are delays in diagnosis throughout this process. Pain complaints in patients vary according to the amount of displacement of the femoral head and how long it takes. While patients with sudden slippage complain of severe pain and inability to walk, patients with slippage as a result of a chronic process can walk, albeit with a limping, and have less pain complaints. It is observed that patients who can walk often walk with their feet turned outwards. A careful examination is sufficient to suspect the diagnosis.

The evaluation of the hip joint with direct radiography is often sufficient for the diagnosis of SCEC. In suspected intermittent patients, it may be necessary to evaluate the hip with MRI.

The patient with the diagnosis of FBEC should not put a load on the hip on the relevant side and should use an assistive device such as crutches or a walker for this.

The aim of the treatment is to prevent further slippage of the femoral head, and to replace the femoral head when necessary in patients with severe slippage. Preventing the slippage of the femoral head is possible by placing one or two screws that stabilize the femoral head in the hip joint. Replacing the femoral head requires a larger surgery that is open to complications. These treatment alternatives should be discussed in detail between the doctor and the patient’s family.

The risk of developing bilateral (on both sides) disease is high in FNECs seen at an early age or with different endocrinological diseases. For this reason, in some of the patients, while the side with slipped femoral head is operated, a possible anti-slip screwing is performed on the opposite normal side.

The two most important complications of FBEC are femoral head osteonecrosis and chondrolysis. Osteonecrosis is a process characterized by impaired blood supply to the femoral head and associated deformities in part or all of the head. In chondrolysis, there is diffuse loss of the cartilage of the femoral head. Both conditions progress with pain and limitation of movement in the hip joint and may result in arthritis in the hip joint in the long term.

FBEK is a disease that requires urgent diagnosis and treatment, and can cause permanent damage to the hip joint if it is not treated quickly with the appropriate method.