What Causes Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) is considered the most common adolescent hip disorder. Skeletal immaturity is evident in radiographic imaging by the presence of a growth plate, or physis. The physis is the active area of skeletally immature bones which allows length to be added to that bone. In the case of the femur, thigh bone, physis, or epiphysial plate, is situated squarely on the neck of the femur. A fracture or crack along the femur physis allows it to slip or move, no longer lining up with the femur neck. This is known as slipped capital femoral epiphysis. Typically occurring in teens and preteens who are still growing, it is not common among younger children. Unlike the word fracture suggests, SCFE is typically a condition that develops gradually, causing pain, stiffness, and instability. It is rarely associated with trauma.

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Radiation And Chemotherapy

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Slipped capital femoral epiphysis typically presents as groin or hip pain on the impacted side, but other times it may trigger thigh or knee pain. Approximately twenty percent of SCFE cases occur bilaterally. This condition typically presents itself during periods of rapid growth, often after the onset of puberty. Radiation and chemotherapy, especially when the radiation is directed to the pelvic region, is associated with an increased risk of slipped capital femoral epiphysis. The risk is heightened, with guidelines recommending avoiding radiation directed near the femoral epiphysis when possible. During periods of active growth, the epiphysis has rapid growth of bone cells. Chemotherapy specifically targets the fastest growing cells in the body in an attempt to destroy them. This goal is established as cancer cells are also fast-growing cells. However, chemotherapy does not distinguish between healthy cells with rapid growth versus cancer cells with rapid growth. Earlier monitoring may prompt treatment before the complete disruption of the growth plate as a direct result of this correlation. It is important to note SCFE may occur many years after the chemotherapy and radiation were delivered.

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