Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis- is a medical term referring to a fracture through the physis (growth plate), which results in slippage of the overlying epiphysis. The head of the femur, called the capital, should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip. 

As Danielle was getting off of the school bus, I noticed she was noticeably limping on her right side. I thought that she may have twisted her ankle at school; perhaps in PE class or running around school.

It's been a couple of years since my last blog post. Danielle is twelve years old now and in her first year of middle school. The transition has been fairly smooth but that is due to the vigilance of a couple of strong parents and the willingness of the school district to work on a long term solution to our children's education...but, that's another story.

Danielle's limp seemed to come out of nowhere. She came home one day and we noticed it right away; it had to be the result of a fall or some sort of injury. I immediately checked to find if there was an "obvious" injury. Though Danielle is very bright and understands almost everything she's told, at 12 years old, her verbal skills are almost non-existent. I asked her if she was hurt and she said, "yes, hurt". That's when the process of elimination begins; starting with her foot and working up to her back. It was clear that her foot was okay and her ankle seemed to have full motion. Her knee wasn't swollen and she was able to move it with no sign of pain. I checked her hip and she seem to be able to lift her leg with no problem so I began to think it was a back problem.
 The following day, Kathy contacted Danielle's home room and PE teachers to ask if she may have been injured in class. Both teachers said they were unaware of any falls or injuries and neither had noticed Danielle's limp. Later that day when Danielle got off of the school bus, we notice Danielle had a very serious limp on her right side. In addition to the pronounced limp, she hesitated as she came down the steps and said  "ouch". Dani's always had a very high threshold for pain so when she expresses discomfort or pain in any way, we consider it serious.
 Kathy noticed that seemed to experience pain and stiffness on her right side whenever she sat still for extended amounts of time. After she got on her feet and walked around for a while, the limp would gradually go away and Danielle would be just fine. We decided to take Danielle to see her pediatrician.

 When we met with the doctor, we were surprised to find that it wasn't her back after all, it was her right hip. X-Rays of Danielle's hip showed that the head of her femur bone was slightly mis-aligned with her hip socket. "Slipped Capital Femoral Epiphysis" is the official medical term for the problem. It is characterized by  the obvious limp and pain in the hip, thigh and/or knee. The doctor said something that I was surprised to hear. She said that children with autism and Downs Syndrome sometimes have weak core and lower body  muscles. This is due to their inability to regulate their metabolism(?).
 Now, it is very possible that I misheard or misunderstood the doctor's explanation. When I got home and began researching this problem, I found nothing referring to autism and Slipped Capital Femoral Epiphysis or and mention of weak core muscularity and the self regulation of  one's metabolism. What is known about Slipped Capital Femoral Epiphysis is that the problem comes from rapid growth, it can be hereditary and is also linked to childhood obesity. Our family doctor referred us to a pediatric orthopedic specialist for a consultation. Fortunately, we were referred the Lucile Packard Children's Hospital at Stanford University.

Lucile Packard Children's Hospital

 When we arrived at LPCH for the consultation with Dr. Young, he looked at Danielle's x-rays and checked the movement in her right hip. He asked us if we had noticed that Danielle's right foot was beginning to turn outward. As a matter of fact, just days earlier Kathy mentioned that Danielle's right foot looked "strange" when she started to limp. About ten minutes into the examination he said, "I don't like to recommend surgery unless it is absolutely necessary. I think this is one of those cases. I'd like to operate this afternoon but I have to check my schedule." I was in total disbelief; I looked at Kathy and she was as shocked as I was. We just came for a consultation, what is this "immediate surgery" talk? Why? What is wrong with my baby?
 When the doctor came back in the room, he said his schedule was full today but he wanted to operate within the next couple of days. I was scared to death, I still wasn't sure what the heck was happening. The doctor explained that the bone could dislocate from the hip which would cause further complications, not to mention immense pain. He also said that by allowing the problem to progress, we could risk a total hip replacement within the next 5 to 10 years.

 The solution is to place a screw through the head of the femoral bone, through the "growth plate", to stabilize the hip and prevent slippage. The operation will take approximately 90 minutes and the recovery time will be 4 to 6 weeks on a walker and/or wheelchair. The prognosis is good, though over time it is possible that she may be a few centimeters shorter on her right side. There should be no need to do any follow up surgery as she gets older. After some discussion, I felt comfortable with the doctor's recommendation. He was confident, knowledgeable and definitely put us at ease with the solution.
 As I was leaving the doctor's office, I was terrified of the prospect of my daughter "going under the knife". The thought of her having a surgical procedure is something that never crossed my mind. As we crossed the street from the clinic to the Lucile Packard Children's Hospital, the reality of my/our situation struck me like a bolt of lighting. There were families from all over the world bringing their children here for treatment of a host of rare illnesses and diseases; parents who are witnessing the child's third, fourth, twelfth surgical procedure with no alternative but to stand strong in the face of uncertainty. For many of these families a 90 minute procedure is a good day..... Talk about sobering reality!
 Danielle's procedure went well, she was out of surgery in little more than an hour. After a brief overnight stay in the hospital, it was back home for 4 to 6 weeks of recovery. According to the doctors, Danielle was not to go upstairs for at least one week. She would need to sleep downstairs and limit her movement. She would need to use a wheel chair for long trips or excursions and she would need to use a walker around the house. It was strongly suggested that Danielle not go to school for at least a couple to weeks.
 Danielle's surgery was Friday afternoon, she returned home of Saturday afternoon. By Sunday evening, she was running through the house,  up and down the stairs. We tried everything to restrict her movement and limit the stress on her hip but we've had little success. Instead of sitting in the wheel chair, she prefer to push it around the house as fast as possible....The walker doesn't stand a chance of being used. The strength and resilience of this kids is unbelievable. I couldn't imagine having a screw placed in my hip on Friday afternoon and running around as if nothing happened by Sunday afternoon. Four to Six Weeks of recovery? More like Four to Six Days.









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