Slipped Capital Femoral Epiphysis

A slipped capital femoral epiphysis (SCFE) is a developmental disorder in which there is dissociation between the epiphysis and metaphysis of the proximal femur. The term is a misnomer because the epiphysis is fixed in the acetabulum and it is the metaphysis, along with the rest of the femur, that slips.

In the vast majority of slips, the epiphysis is posteromedial with respect to the metaphysis. A SCFE usually occurs during the adolescent growth spurt and is bilateral in about one-third of cases. Sixty to 65% of patients are above the 90th percentile for weight.


Patients usually present with pain and a limp. The extremity is usually rotated externally and the time spent on the leg is less than the unaffected leg. The gait produced from this shortened time on the leg is called an antalgic gait and is an indication of pain with weight bearing. The pain is frequently in the thigh or knee despite the pathology being at the hip. The physical exam is most remarkable for limitation of internal rotation of the hip. Radiographs are usually diagnostic and are used to grade the severity of the slip. Occasionally, an MRI is needed to visualize a very early SCFE or "preslip." SCFEs are classified as acute if symptoms have been present for less than 3 weeks, and chronic or acute-on-chronic if there has been a recent exacerbation. They are also classified as stable or unstable depending on whether the patient can bear weight. Acute, unstable slips require emergent treatment.


The treatment of virtually all SCFEs is to stabilize the slip with one partially-threaded, cannulated screw. Reducing the slippage is contraindicated because it damages the blood supply to the epiphysis and may cause osteonecrosis of the femoral head. Occasionally, a reconstructive osteotomy is required to improve the mechanics of the joint.