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Slipped Capital Femoral Epiphysis – Causes & Treatment

Slipped capital femoral epiphysis (SCFE) is a hip condition in growing children where the femoral head slips off the growth plate. It most commonly affects adolescents during puberty.

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Things worth knowing about "Slipped Capital Femoral Epiphysis"

Slipped capital femoral epiphysis (SCFE) is a hip condition in growing children where the femoral head slips off the growth plate. It most commonly affects adolescents during puberty.

What is Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE, also known as epiphyseolysis capitis femoris) is an orthopedic condition affecting the growing skeleton. In this condition, the head of the femur (thighbone) slips backward and downward along the growth plate (physis), leading to a misalignment of the hip joint. Without timely treatment, SCFE can result in permanent hip damage. It is the most common hip disorder in adolescents.

Causes and Risk Factors

The exact cause of SCFE is not fully understood, but the condition is thought to result from a combination of mechanical stress and hormonal factors that weaken the growth plate.

Obesity: Excess body weight dramatically increases mechanical load on the hip growth plate and is the most significant risk factor.
Hormonal disorders: Conditions such as hypothyroidism, growth hormone deficiency, and hypopituitarism can reduce the strength of the physis.
Genetic predisposition: A family history of SCFE increases risk.
Male sex: Boys are more commonly affected than girls.
Bilateral involvement: Up to 40% of patients develop SCFE in both hips.

Symptoms

Symptoms may develop gradually (chronic SCFE) or suddenly (acute SCFE). Pain is frequently referred to the knee or thigh rather than the hip, which can delay diagnosis.

Hip, groin, thigh, or knee pain
Limping or an altered gait pattern
Reduced range of motion in the hip, especially internal rotation
Spontaneous external rotation of the affected leg during walking
In acute cases: sudden severe pain with inability to bear weight

Classification

SCFE is classified by its onset and the degree of slippage:

Acute SCFE: Sudden onset, often following minor trauma, with immediate severe symptoms.
Chronic SCFE: Gradual slip developing over weeks to months.
Acute-on-chronic SCFE: A sudden worsening of a previously existing chronic slip.
Stable vs. unstable SCFE: In unstable SCFE, the patient cannot bear weight; this form carries a significantly higher risk of avascular necrosis.

Diagnosis

Diagnosis is based on clinical examination and imaging studies. Early diagnosis is critical to prevent progression and complications.

Physical examination: The Drehmann sign is characteristic: when the hip is flexed, the leg involuntarily rotates outward.
X-ray: Standard anteroposterior and lateral (frog-leg) pelvic radiographs typically show the femoral head displacement.
MRI (Magnetic Resonance Imaging): Particularly useful for early detection, as it can reveal physeal changes before a visible slip occurs.

Treatment

Treatment of SCFE is always surgical, as the slip must be stabilized to prevent further progression. Conservative management alone is insufficient.

In Situ Fixation

The standard treatment is in situ fixation, in which the femoral head is stabilized in its current position using a cannulated (hollow) screw, without attempting to reposition the head. The goal is to halt further slippage and promote closure of the growth plate.

Reduction and Osteotomy

In cases of severe slippage, surgical correction through an osteotomy (a controlled bone cut and realignment) may be required. These procedures are technically demanding and carry greater surgical risk.

Prophylactic Fixation of the Contralateral Hip

In patients at high risk of bilateral SCFE, prophylactic fixation of the unaffected hip may be considered to prevent a second slip.

Complications

If untreated or diagnosed late, SCFE can lead to serious long-term complications:

Avascular necrosis: Death of the femoral head due to disrupted blood supply
Chondrolysis: Destruction of the articular cartilage
Early-onset osteoarthritis (coxarthrosis): Premature degeneration of the hip joint
Femoroacetabular impingement (FAI): Mechanical conflict between bone structures resulting from abnormal hip geometry

Prognosis

When diagnosed and surgically stabilized early, the prognosis for SCFE is generally favorable. Long-term outcomes depend on the degree of slippage, stability of the slip, and the presence of complications. Regular orthopedic follow-up is essential after treatment to detect any emerging problems at an early stage.

References

Loder RT, Aronsson DD, Dobbs MB, Weinstein SL. Slipped capital femoral epiphysis. Journal of Bone and Joint Surgery, 2000.
Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clinical Orthopaedics and Related Research, 2008.
Kim HK. Pathophysiology and new strategies for the treatment of Legg-Calve-Perthes disease. Journal of Bone and Joint Surgery, 2012.

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