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Slipped Capital Femoral Epiphysis (SCFE)

Adolescent hip disorder with posterior and inferior displacement of the femoral head epiphysis through the proximal femoral physis, requiring urgent surgical fixation to prevent severe arthritic complications.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

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What is Slipped Capital Femoral Epiphysis (SCFE)?

SCFE pathogenesis: relative weakening of the proximal femoral physis (perichondrial ring, hypertrophic zone) with mechanical and endocrine factors. The femoral head essentially stays in the acetabulum while the femoral neck displaces anteriorly, superiorly, and externally rotates relative to the head — net effect is posterior-inferior epiphyseal displacement.

Risk factors: obesity (BMI >95th percentile), peri-pubertal age (mean 11-13 girls, 13-15 boys), endocrine disorders (hypothyroidism, growth hormone deficiency or excess, panhypopituitarism, renal osteodystrophy), genetic predisposition. Atypical SCFE in younger children or thinner adolescents requires endocrine workup.

Classification: Loder stability (stable — patient can bear weight, even with crutches; unstable — cannot bear weight, more severe slip, much higher AVN risk); chronicity (acute <3 weeks symptoms, chronic >3 weeks, acute-on-chronic); Southwick angle severity (mild <30°, moderate 30-50°, severe >50°).

Symptoms

Adolescent hip, groin, thigh, or knee pain (often referred to knee — important diagnostic pearl)
Limp or antalgic gait
Limited internal rotation of hip (most reliable physical sign)
Obligatory external rotation with hip flexion (Drehmann's sign)
Decreased range of motion (especially internal rotation, flexion)
Inability to bear weight (unstable SCFE)
Bilateral symptoms in 20-50%
Slow progression in chronic; acute on minor trauma in unstable

Risk Factors

Obesity (BMI >95th percentile, biggest risk factor)
Peri-pubertal age (girls 11-13, boys 13-15)
Male sex (slight male predominance)
African American ancestry (higher rates)
Endocrine disorders (hypothyroidism, GH abnormalities, hypogonadism, renal osteodystrophy)
Family history of SCFE
Younger or thinner patients with SCFE — workup for endocrine cause

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Adolescent hip, groin, thigh, or KNEE pain — assess hip thoroughly!
  • Limp in adolescent
  • Limited hip internal rotation
  • Obligatory external rotation with hip flexion
  • Inability to bear weight (URGENT — unstable SCFE)
  • Pediatric orthopedic emergency referral

Treatment Methods

01
Diagnostic imaging: AP pelvis and frog-lateral hip X-rays — frog-lateral most sensitive; Klein's line (line drawn along superior femoral neck should intersect epiphysis — if not, SCFE); Southwick angle measurement
02
MRI: useful for pre-slip (hip pain with normal X-rays but physeal widening on MRI), AVN assessment post-fixation
03
Initial management — STRICT NON-WEIGHT-BEARING: until surgical fixation; do not allow patient to ambulate (risk of acute slip progression); admit and surgical fixation as soon as possible
04
In situ percutaneous fixation for stable mild-moderate SCFE: cannulated screw (single screw 6.5-7.3 mm typically, or two screws for higher severity) inserted percutaneously under fluoroscopic guidance perpendicular to physis crossing into epiphysis, threaded portion in epiphysis only (avoid joint penetration); ~95% success in stable SCFE
05
Prophylactic contralateral pinning: controversial; most surgeons offer prophylactic fixation if endocrine cause, age <10, severe risk factors, or bilateral signs; some routinely fix contralateral hip due to high contralateral SCFE rate
06
Modified Dunn procedure (subcapital osteotomy): for severe slips (>50°) or unstable SCFE — anatomic reduction of epiphysis on neck through surgical hip dislocation approach (Ganz technique); requires specialized expertise; reduces avascular necrosis risk theoretically by careful vascular preservation but data mixed
07
Subtrochanteric or intertrochanteric osteotomy: in chronic severe slips with healed physis — corrective osteotomy distal to femoral head to restore hip alignment without compromising femoral head vascularity; lower AVN risk but less anatomic correction
08
Acute SCFE: severe slips with unstable presentation — emergency reduction (gentle, no forceful manipulation) and fixation; modified Dunn procedure consideration in severe unstable SCFE
09
Postoperative care: non-weight-bearing or partial weight-bearing 4-6 weeks (variable), then progressive; physiotherapy for hip ROM and strength; serial X-rays at 6 weeks, 3 months, 6 months, annually until physeal closure
10
Avascular necrosis (AVN): major complication, especially in unstable SCFE (10-50%); diagnosed by MRI 6 weeks-6 months postoperatively; bone scan; may require additional surgery (femoral head resurfacing, joint preservation procedures, total hip arthroplasty in young adult)
11
Chondrolysis: cartilage destruction, especially with intra-articular hardware penetration or prominent screws; presents with pain and stiffness postoperatively; treatment supportive, may require revision
12
Femoroacetabular impingement (FAI): often develops after SCFE due to residual deformity (bump on femoral head-neck junction); osteochondroplasty may be needed for symptomatic FAI
13
Long-term: most stable SCFE patients with successful fixation maintain good function long-term; severe slips and AVN cases may develop early hip arthritis requiring eventual hip replacement; multidisciplinary follow-up especially with endocrine causes

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.