What Causes Slipped Capital Femoral Epiphysis?

March 13, 2024

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

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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Kidney Disease

Slipped capital femoral epiphysis has a poorly understood etiology; however, it represents one of the more important adolescent hip disorders due to its potential for poor outcomes without proper treatment. Identification is difficult due to its multifactorial causations. Endocrine or metabolic disorders in children are associated with an increased risk. Kidney disease, most notably renal osteodystrophy, is a primary cause of bone metabolic changes. These disorders allow abnormal hormone and blood levels of calcium and phosphorus. The proper balance of hormones and blood are imperative to bone health, as they give bone its strength. Alterations in bone mineralization increase the risk of slipped capital femoral epiphysis in adolescents by making the area weaker and more susceptible to mild trauma. Children with this medical history should be closely evaluated for any potential symptoms of SCFE.

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Diabetes

Systemic endocrine disorders are considered primary causes for slipped capital femoral epiphysis in children. These endocrine disorders are considered the most common etiology of SCFE except idiopathic. This condition is recognized to be multifactorial, with several factors playing a role in its development. For this reason, current medical guidelines recommend quicker evaluation via radiographic imaging for hip, groin or knee pain in children with endocrine or metabolic disorders, such as diabetes. Around eight percent of the US population, including 187,000 children younger than twenty years old, has been diagnosed with diabetes and the rate of incidence is increasing rapidly. Not only should the above symptoms be monitored closer in adolescents with endocrine disorders, but they should also be monitored closely for a longer period. Forty percent will have slipped capital femoral epiphysis occur on the opposite side within eighteen months.

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Certain Medications

Slipped capital femoral epiphysis must be properly evaluated by a physician. Delays in diagnosis are common, typically the result of the vague presenting symptoms and lack of risk factors. However, the prognosis of SCFE is directly related to how promptly the condition is diagnosed and treated. Proper evaluation of a child with potential slipped capital femoral epiphysis must include a thorough history of the complaint, past medical history, and family history. Through this history, certain medications and nutritional supplements associated with SCFE must be noted. These include growth hormone supplementation, drugs in the gonadotropin-releasing hormone family, and corticosteroids, all of which increase the risk of slipped capital femoral epiphysis. Current research indicates that alone these medications and supplements minimally increase the risk, but when coupled with other risk factors, SCFE must be ruled out quickly. The common component these medications share is a chemically-induced alteration in bone health.

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Obesity

Slipped capital femoral epiphysis is rare, with an incidence of ten cases per 100,000 males. Childhood obesity, defined by the Center For Disease Control as a body mass index in the ninety-fifth percentile or above. This risk factor is the strongest indicator for SCFE, increasing the risk of developing it twenty times the normal rate. Research concludes sixty-three percent of children diagnosed with slipped capital femoral epiphysis have a weight in the ninetieth percentile or above. It is believed the additional weight results in aberrant stressors on the hip joint. When this is coupled with additional risks, it is strong enough to alter the impact on the growth plate, causing it to slip over time or with minimal trauma. Childhood obesity is directly correlated to metabolic changes, endocrine dysfunction and other individual causes themselves of SCFE. Slipped capital femoral epiphysis is associated with complications such as avascular necrosis, chondrolysis, and early-onset degenerative changes to the hip. All children with potential SCFE should be evaluated thoroughly by a highly qualified health professional. Radiographic imaging of the hip and pelvis can be utilized to confirm diagnosis and tailor treatment.

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