Slipped capital femoral epiphysis (SCFE) also referred to as slipped upper femoral epiphysis (SUFE) is the leading hip condition seen in children and adolescents, characterized by instability at the proximal femoral growth plate. The development is thought to result from a combination of mechanical stressors and underlying constitutional factors. While it is an uncommon disorder, SCFE is clinically significant because delayed recognition can lead to serious consequences, most notably avascular necrosis of the femoral head. Diagnosis is often challenging since the condition may present with non-specific symptoms such as knee or medial thigh pain, or may follow a slow, progressive course that obscures the underlying hip pathology. Typical clinical features include complaints of hip, thigh or knee discomfort, the presence of a limp that can appear suddenly or gradually, and restricted hip mobility. Given these varied presentations, clinicians must maintain vigilance when evaluating young patients with leg pain to ensure early detection and prompt management, thereby minimizing the risk of long-term complications.
Epidemiology
SCFE is among the most frequent hip conditions affecting older children and adolescents, with a reported U.S. incidence of approximately 10.8 per 100,000 (range 0.33–24.8/100,000). The condition occurs more often in boys than in girls, with mean ages of onset of 12.0 years and 11.2 years, respectively. Higher incidence is observed in Black and Hispanic populations compared with White children, and geographically, rates are greater in the Northeast and Western regions than in the Midwest and South. Seasonal fluctuations have been described, with increased cases during the summer in areas north of 40º latitude, during winter in regions south of 40º and nationwide peaks in late summer (August/September), with a secondary peak in early spring (March/April) in the Southern states.
Most cases develop between ages 10 and 16, though more recent reports suggest earlier onset and a higher frequency of bilateral disease, likely associated with the obesity epidemic. Around one-fifth of patients initially present with both hips affected, and an additional 20 to 40% experience a second slip within 18 months, the left side tends to be more commonly involved, and bilateral rates overall range from 8% to 50%. Excess weight is the strongest predictor, but other contributing factors include male sex, rapid growth phases, endocrine disorders like hypothyroidism and growth hormone deficiency, pituitary or craniopharyngioma tumors, Down syndrome, renal osteodystrophy, prior hip irradiation and acetabular or femoral retroversion which increase shear forces across the physis. Physical activity is also linked with about one-third of cases associated with sports specifically basketball, football and baseball/softball. Regional analyses, including data from New Mexico suggest rising incidence tied to increasing childhood obesity and improved access to orthopedic services, despite national rates appearing relatively unchanged.
Anatomy
Pathophysiology
The pathogenesis of SCFE is complex and not fully defined, but it is thought to occur when excessive axial loading acts on a vulnerable physis. Obesity amplifies mechanical stress, while endocrine or renal disorders further compromise physeal strength. In this condition, the epiphysis stays seated in the acetabulum, while the metaphysis rotates externally and shifts anteriorly, with slippage occurring through the hypertrophic zone. Adolescents are particularly at risk due to structural changes such as a more vertical physis, thinning of the perichondrial ring of La Croix, and reduced stability from the mamillary processes.
SCFE is classified as a Salter-Harris type I fracture showing variable periosteal integrity depending on whether the presentation is acute or chronic. The hypertrophic zone, normally 15 to 30% of the physis, may expand to as much as 80% in affected patients, causing widening of the growth plate. Histological changes include disorganized cartilage maturation, abnormal endochondral ossification, and disruption of the columnar architecture, all of which weaken the physis. Growth-related alterations like the shift of the physis from a horizontal to oblique orientation, combined with femoral neck retroversion or reduced neck-shaft angle, further increase shear stress across the hip. Additional findings including synovitis, irregular collagen fibrils, and accumulation of proteoglycans and glycoproteins, have been observed, though it remains uncertain whether these represent causes or consequences of SCFE.
Etiology
SCFE cases are mostly idiopathic. There is no history of injury or trauma before the symptom’s onset. A link has found between patients with endocrine disease like hyperthyroidism, hypothyroidism, growth hormone deficiency, panhypopituitarism, Down syndrome, renal disease and development of SCFE. Hypothyroidism is most common etiology of the nonidiopathic SCFE.
Genetics
Prognostic Factors
Patients who have SCFE who are treated with in situ fixation can do well. In cases with severe slippage and deformity, long term sequalae can occur like osteoarthritis, stiffness, leg length discrepancy, chondrolysis. Conservative methods like treatment, assistive aid, orthotics and analgesics are used for symptomatic relief and then urgent operative care is indicated. Adult patients with loss of motion, unremitting pain and secondary stiffness to chondrolysis, osteoarthritis or AVN can need salvage hip arthrodesis. In cases where hips are incompletely damages, proximal osteotomies can used to redirect the joint force inro damaged area of articular femoral head.
Complications
If left untreated, SCFE can lead to progressive hip deformity, pain, instability of the femoral epiphysis and restricted motion. Major complications include avascular necrosis (AVN) which occurs in up to 47% of unstable cases because of vascular injury at the time of slip or during surgical reduction and often resulting in the eventual need for total hip replacement. Chondrolysis or cartilage destruction leading to joint space narrowing may arise from intra-articular hardware or independent of treatment. Long-term patients are at risk for osteoarthritis specifically in severe slips because of AVN, chondrolysis or altered biomechanics. Additional complications include leg-length discrepancy from AVN, coxa vara or incomplete reduction, hardware-related issues like failure or outgrowth and rarely postoperative infection.
Clinical History
SCFE occurs during adolescence typically between ages 10 to 16 in boys and 12 to 14 in girls with males having a 2.4-fold higher risk. The left hip is more frequently affected and obesity is a key risk factor because of increased shear forces across the proximal growth plate. Clinicians should suspect SCFE in adolescents or young adults presenting with atraumatic hip, thigh or knee pain specifically when accompanied by limping or weight-bearing difficulty. While hip pain is most common (52%), discomfort may also occur in the groin (13.9%), thigh (35%) or knee (26%) with knee pain often referred by the obturator nerve.
Symptoms typically precede diagnosis by 4 to 5 months though onset may be as short as under 3 weeks. Trauma is not usually reported but its presence does not rule out SCFE. Patients may adopt a position of crossing the affected leg over the other. Family history may play a role with 5 to 7% familial involvement and penetrance is variable. In children under 10, SCFE is often linked to metabolic or endocrine disorders like hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy or growth hormone abnormalities and bilateral involvement is more common in these cases.
The disease chronicity must be determined by prodromal symptoms like knee of hip pain, reduced range of motion, limp for < 3 weeks is considered as acute. Prodromal symptoms for > 3 weeks are considered chronic.
Physical examination
The affected extremity may exhibit limited internal rotation and passive internal rotation can lead to discomfort. Internal rotation, abduction and hip flexion can be reduced. The patient may exhibit the Drehmann sign which is required external rotation with the passive hip flexion to 90 degree. The patient can have Trendelenburg, shuffling, total inability to bear the weight or antalgic. Thigh atrophy can or cannot exist.
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Osteitis pubis
Groin injury
Femur fracture and injury
Femoral neck stress fracture
Femoral neck fracture
Femoral head avascular necrosis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment paradigm
The treatment paradigm of SCFE is primarily surgical with the approach determined by slip stability, severity and risk of contralateral involvement.
In situ fixation: The standard management for both stable and unstable SCFE is in situ fixation with percutaneous screw placement which aims to prevent further displacement of the epiphysis while minimizing the risk of vascular injury.
The screw should be positioned centrally and perpendicular to the physis under fluoroscopic guidance ensuring at least five threads engage the epiphysis without violating the articular surface. One screw is typically sufficient, though two screws may enhance stability at the expense of a higher complication rate. Postoperatively, patients with stable slips are usually permitted full weight-bearing while those with unstable slips are restricted to partial weight-bearing for about six weeks.
Capsulotomy: Capsulotomy may be performed in unstable cases to reduce intracapsular pressure, although its impact on reducing avascular necrosis (AVN) remains unclear. Prophylactic fixation of the contralateral hip is controversial but may be considered in high-risk groups such as young children, obese males and those with endocrine disorders.
I Modified Dunn Procedure: In severe or unstable SCFE, open reduction and internal fixation via the modified Dunn procedure may be indicated. This technically demanding technique involves surgical hip dislocation, correction of the deformity and fixation of the epiphysis while preserving the femoral head blood supply.
Osteochondroplasty: For patients with residual deformity or femoroacetabular impingement due to metaphyseal prominence, osteochondroplasty may be performed either arthroscopically, through a limited anterior arthrotomy, or with surgical dislocation.
More severe deformities with slip angles exceeding 30 to 45 degrees may necessitate proximal femoral osteotomy, with intertrochanteric, subtrochanteric or femoral neck osteotomies used depending on the degree of correction required.
Postoperative and Rehabilitation Care: Postoperative rehabilitation is essential but poorly standardized in the literature. Recovery typically follows a five-phase program, beginning with inflammation reduction, gait training and early range of motion followed by gradual withdrawal of crutches, progressive strengthening, and aerobic conditioning and culminating in the restoration of functional power for return to daily activity or sport. Ultimately, the treatment of SCFE focuses on stabilizing the slip, preserving femoral head vascularity, correcting residual deformity when necessary and restoring hip function while minimizing long-term complications like AVN, chondrolysis, and osteoarthritis.
Medications
There is no medication is available for SCFE treatment then symptomatic pain relief. This can include nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics or acetaminophen.
Use of Antipyretics/Analgesics to treat SCFE
Pain control is necessary for quality patient care. Analgesics make sure patient comfort. It has sedative properties which is beneficial to patient who has continuous trauma or injuries.
Acetaminophen: It is prescribed to patient who has hypersensitivity to NSAIDS or aspirin with upper gastrointestinal disease or taking other oral anticoagulants.
Acetaminophen and hydrocodone: It is a combination drug which is given during mild to severe pain.
Acetaminophen/codeine (Tylenol): It is prescribed for mild to moderate pain. The dosage form of tylenol is 300 mg acetaminophen/15 or 30 or 60 mg codeine.
Use of NSAIDS to treat SCFE
NSAIDs have anti-inflammatory, analgesic and antipyretic properties. It can inhibit the cyclooxygenase activity and systemises of prostaglandin. Other mechanisms include inhibition of synthesis of leukotriene, lipoxygenase activity, lysosomal enzyme release, neutrophil aggregation and different cell membrane function.
Ibuprofen: It is prescribed during mild to moderate pain. It inhibits the inflammatory reaction and pain by reducing the synthesis of prostaglandin.
Ketoprofen: It is indicated for moderate to mild pain and inflammation. Small dosage in the initially are indicated in elder and small patients and who have liver or renal disease. Dosages more than 75 mg do not elevate therapeutic effects. Administer higher dosage with caution and observe the patient closely.
Naproxen: It is indicated for moderate to mild pain. It inhibits the inflammatory reaction and reducing activity of cyclooxygenase which can lead to reduction of synthesise of prostaglandin.
»
Home » CAD » Slipped Capital Femoral Epiphysis
Slipped Capital Femoral Epiphysis
Updated :
September 26, 2025
Slipped capital femoral epiphysis (SCFE) also referred to as slipped upper femoral epiphysis (SUFE) is the leading hip condition seen in children and adolescents, characterized by instability at the proximal femoral growth plate. The development is thought to result from a combination of mechanical stressors and underlying constitutional factors. While it is an uncommon disorder, SCFE is clinically significant because delayed recognition can lead to serious consequences, most notably avascular necrosis of the femoral head. Diagnosis is often challenging since the condition may present with non-specific symptoms such as knee or medial thigh pain, or may follow a slow, progressive course that obscures the underlying hip pathology. Typical clinical features include complaints of hip, thigh or knee discomfort, the presence of a limp that can appear suddenly or gradually, and restricted hip mobility. Given these varied presentations, clinicians must maintain vigilance when evaluating young patients with leg pain to ensure early detection and prompt management, thereby minimizing the risk of long-term complications.
SCFE is among the most frequent hip conditions affecting older children and adolescents, with a reported U.S. incidence of approximately 10.8 per 100,000 (range 0.33–24.8/100,000). The condition occurs more often in boys than in girls, with mean ages of onset of 12.0 years and 11.2 years, respectively. Higher incidence is observed in Black and Hispanic populations compared with White children, and geographically, rates are greater in the Northeast and Western regions than in the Midwest and South. Seasonal fluctuations have been described, with increased cases during the summer in areas north of 40º latitude, during winter in regions south of 40º and nationwide peaks in late summer (August/September), with a secondary peak in early spring (March/April) in the Southern states.
Most cases develop between ages 10 and 16, though more recent reports suggest earlier onset and a higher frequency of bilateral disease, likely associated with the obesity epidemic. Around one-fifth of patients initially present with both hips affected, and an additional 20 to 40% experience a second slip within 18 months, the left side tends to be more commonly involved, and bilateral rates overall range from 8% to 50%. Excess weight is the strongest predictor, but other contributing factors include male sex, rapid growth phases, endocrine disorders like hypothyroidism and growth hormone deficiency, pituitary or craniopharyngioma tumors, Down syndrome, renal osteodystrophy, prior hip irradiation and acetabular or femoral retroversion which increase shear forces across the physis. Physical activity is also linked with about one-third of cases associated with sports specifically basketball, football and baseball/softball. Regional analyses, including data from New Mexico suggest rising incidence tied to increasing childhood obesity and improved access to orthopedic services, despite national rates appearing relatively unchanged.
The pathogenesis of SCFE is complex and not fully defined, but it is thought to occur when excessive axial loading acts on a vulnerable physis. Obesity amplifies mechanical stress, while endocrine or renal disorders further compromise physeal strength. In this condition, the epiphysis stays seated in the acetabulum, while the metaphysis rotates externally and shifts anteriorly, with slippage occurring through the hypertrophic zone. Adolescents are particularly at risk due to structural changes such as a more vertical physis, thinning of the perichondrial ring of La Croix, and reduced stability from the mamillary processes.
SCFE is classified as a Salter-Harris type I fracture showing variable periosteal integrity depending on whether the presentation is acute or chronic. The hypertrophic zone, normally 15 to 30% of the physis, may expand to as much as 80% in affected patients, causing widening of the growth plate. Histological changes include disorganized cartilage maturation, abnormal endochondral ossification, and disruption of the columnar architecture, all of which weaken the physis. Growth-related alterations like the shift of the physis from a horizontal to oblique orientation, combined with femoral neck retroversion or reduced neck-shaft angle, further increase shear stress across the hip. Additional findings including synovitis, irregular collagen fibrils, and accumulation of proteoglycans and glycoproteins, have been observed, though it remains uncertain whether these represent causes or consequences of SCFE.
SCFE cases are mostly idiopathic. There is no history of injury or trauma before the symptom’s onset. A link has found between patients with endocrine disease like hyperthyroidism, hypothyroidism, growth hormone deficiency, panhypopituitarism, Down syndrome, renal disease and development of SCFE. Hypothyroidism is most common etiology of the nonidiopathic SCFE.
Patients who have SCFE who are treated with in situ fixation can do well. In cases with severe slippage and deformity, long term sequalae can occur like osteoarthritis, stiffness, leg length discrepancy, chondrolysis. Conservative methods like treatment, assistive aid, orthotics and analgesics are used for symptomatic relief and then urgent operative care is indicated. Adult patients with loss of motion, unremitting pain and secondary stiffness to chondrolysis, osteoarthritis or AVN can need salvage hip arthrodesis. In cases where hips are incompletely damages, proximal osteotomies can used to redirect the joint force inro damaged area of articular femoral head.
Complications
If left untreated, SCFE can lead to progressive hip deformity, pain, instability of the femoral epiphysis and restricted motion. Major complications include avascular necrosis (AVN) which occurs in up to 47% of unstable cases because of vascular injury at the time of slip or during surgical reduction and often resulting in the eventual need for total hip replacement. Chondrolysis or cartilage destruction leading to joint space narrowing may arise from intra-articular hardware or independent of treatment. Long-term patients are at risk for osteoarthritis specifically in severe slips because of AVN, chondrolysis or altered biomechanics. Additional complications include leg-length discrepancy from AVN, coxa vara or incomplete reduction, hardware-related issues like failure or outgrowth and rarely postoperative infection.
SCFE occurs during adolescence typically between ages 10 to 16 in boys and 12 to 14 in girls with males having a 2.4-fold higher risk. The left hip is more frequently affected and obesity is a key risk factor because of increased shear forces across the proximal growth plate. Clinicians should suspect SCFE in adolescents or young adults presenting with atraumatic hip, thigh or knee pain specifically when accompanied by limping or weight-bearing difficulty. While hip pain is most common (52%), discomfort may also occur in the groin (13.9%), thigh (35%) or knee (26%) with knee pain often referred by the obturator nerve.
Symptoms typically precede diagnosis by 4 to 5 months though onset may be as short as under 3 weeks. Trauma is not usually reported but its presence does not rule out SCFE. Patients may adopt a position of crossing the affected leg over the other. Family history may play a role with 5 to 7% familial involvement and penetrance is variable. In children under 10, SCFE is often linked to metabolic or endocrine disorders like hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy or growth hormone abnormalities and bilateral involvement is more common in these cases.
The disease chronicity must be determined by prodromal symptoms like knee of hip pain, reduced range of motion, limp for < 3 weeks is considered as acute. Prodromal symptoms for > 3 weeks are considered chronic.
Physical examination
The affected extremity may exhibit limited internal rotation and passive internal rotation can lead to discomfort. Internal rotation, abduction and hip flexion can be reduced. The patient may exhibit the Drehmann sign which is required external rotation with the passive hip flexion to 90 degree. The patient can have Trendelenburg, shuffling, total inability to bear the weight or antalgic. Thigh atrophy can or cannot exist.
Osteitis pubis
Groin injury
Femur fracture and injury
Femoral neck stress fracture
Femoral neck fracture
Femoral head avascular necrosis
Treatment paradigm
The treatment paradigm of SCFE is primarily surgical with the approach determined by slip stability, severity and risk of contralateral involvement.
In situ fixation: The standard management for both stable and unstable SCFE is in situ fixation with percutaneous screw placement which aims to prevent further displacement of the epiphysis while minimizing the risk of vascular injury.
The screw should be positioned centrally and perpendicular to the physis under fluoroscopic guidance ensuring at least five threads engage the epiphysis without violating the articular surface. One screw is typically sufficient, though two screws may enhance stability at the expense of a higher complication rate. Postoperatively, patients with stable slips are usually permitted full weight-bearing while those with unstable slips are restricted to partial weight-bearing for about six weeks.
Capsulotomy: Capsulotomy may be performed in unstable cases to reduce intracapsular pressure, although its impact on reducing avascular necrosis (AVN) remains unclear. Prophylactic fixation of the contralateral hip is controversial but may be considered in high-risk groups such as young children, obese males and those with endocrine disorders.
I Modified Dunn Procedure: In severe or unstable SCFE, open reduction and internal fixation via the modified Dunn procedure may be indicated. This technically demanding technique involves surgical hip dislocation, correction of the deformity and fixation of the epiphysis while preserving the femoral head blood supply.
Osteochondroplasty: For patients with residual deformity or femoroacetabular impingement due to metaphyseal prominence, osteochondroplasty may be performed either arthroscopically, through a limited anterior arthrotomy, or with surgical dislocation.
More severe deformities with slip angles exceeding 30 to 45 degrees may necessitate proximal femoral osteotomy, with intertrochanteric, subtrochanteric or femoral neck osteotomies used depending on the degree of correction required.
Postoperative and Rehabilitation Care: Postoperative rehabilitation is essential but poorly standardized in the literature. Recovery typically follows a five-phase program, beginning with inflammation reduction, gait training and early range of motion followed by gradual withdrawal of crutches, progressive strengthening, and aerobic conditioning and culminating in the restoration of functional power for return to daily activity or sport. Ultimately, the treatment of SCFE focuses on stabilizing the slip, preserving femoral head vascularity, correcting residual deformity when necessary and restoring hip function while minimizing long-term complications like AVN, chondrolysis, and osteoarthritis.
Medications
There is no medication is available for SCFE treatment then symptomatic pain relief. This can include nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics or acetaminophen.
Use of Antipyretics/Analgesics to treat SCFE
Pain control is necessary for quality patient care. Analgesics make sure patient comfort. It has sedative properties which is beneficial to patient who has continuous trauma or injuries.
Acetaminophen: It is prescribed to patient who has hypersensitivity to NSAIDS or aspirin with upper gastrointestinal disease or taking other oral anticoagulants.
Acetaminophen and hydrocodone: It is a combination drug which is given during mild to severe pain.
Acetaminophen/codeine (Tylenol): It is prescribed for mild to moderate pain. The dosage form of tylenol is 300 mg acetaminophen/15 or 30 or 60 mg codeine.
Use of NSAIDS to treat SCFE
NSAIDs have anti-inflammatory, analgesic and antipyretic properties. It can inhibit the cyclooxygenase activity and systemises of prostaglandin. Other mechanisms include inhibition of synthesis of leukotriene, lipoxygenase activity, lysosomal enzyme release, neutrophil aggregation and different cell membrane function.
Ibuprofen: It is prescribed during mild to moderate pain. It inhibits the inflammatory reaction and pain by reducing the synthesis of prostaglandin.
Ketoprofen: It is indicated for moderate to mild pain and inflammation. Small dosage in the initially are indicated in elder and small patients and who have liver or renal disease. Dosages more than 75 mg do not elevate therapeutic effects. Administer higher dosage with caution and observe the patient closely.
Naproxen: It is indicated for moderate to mild pain. It inhibits the inflammatory reaction and reducing activity of cyclooxygenase which can lead to reduction of synthesise of prostaglandin.
Slipped capital femoral epiphysis (SCFE) also referred to as slipped upper femoral epiphysis (SUFE) is the leading hip condition seen in children and adolescents, characterized by instability at the proximal femoral growth plate. The development is thought to result from a combination of mechanical stressors and underlying constitutional factors. While it is an uncommon disorder, SCFE is clinically significant because delayed recognition can lead to serious consequences, most notably avascular necrosis of the femoral head. Diagnosis is often challenging since the condition may present with non-specific symptoms such as knee or medial thigh pain, or may follow a slow, progressive course that obscures the underlying hip pathology. Typical clinical features include complaints of hip, thigh or knee discomfort, the presence of a limp that can appear suddenly or gradually, and restricted hip mobility. Given these varied presentations, clinicians must maintain vigilance when evaluating young patients with leg pain to ensure early detection and prompt management, thereby minimizing the risk of long-term complications.
SCFE is among the most frequent hip conditions affecting older children and adolescents, with a reported U.S. incidence of approximately 10.8 per 100,000 (range 0.33–24.8/100,000). The condition occurs more often in boys than in girls, with mean ages of onset of 12.0 years and 11.2 years, respectively. Higher incidence is observed in Black and Hispanic populations compared with White children, and geographically, rates are greater in the Northeast and Western regions than in the Midwest and South. Seasonal fluctuations have been described, with increased cases during the summer in areas north of 40º latitude, during winter in regions south of 40º and nationwide peaks in late summer (August/September), with a secondary peak in early spring (March/April) in the Southern states.
Most cases develop between ages 10 and 16, though more recent reports suggest earlier onset and a higher frequency of bilateral disease, likely associated with the obesity epidemic. Around one-fifth of patients initially present with both hips affected, and an additional 20 to 40% experience a second slip within 18 months, the left side tends to be more commonly involved, and bilateral rates overall range from 8% to 50%. Excess weight is the strongest predictor, but other contributing factors include male sex, rapid growth phases, endocrine disorders like hypothyroidism and growth hormone deficiency, pituitary or craniopharyngioma tumors, Down syndrome, renal osteodystrophy, prior hip irradiation and acetabular or femoral retroversion which increase shear forces across the physis. Physical activity is also linked with about one-third of cases associated with sports specifically basketball, football and baseball/softball. Regional analyses, including data from New Mexico suggest rising incidence tied to increasing childhood obesity and improved access to orthopedic services, despite national rates appearing relatively unchanged.
The pathogenesis of SCFE is complex and not fully defined, but it is thought to occur when excessive axial loading acts on a vulnerable physis. Obesity amplifies mechanical stress, while endocrine or renal disorders further compromise physeal strength. In this condition, the epiphysis stays seated in the acetabulum, while the metaphysis rotates externally and shifts anteriorly, with slippage occurring through the hypertrophic zone. Adolescents are particularly at risk due to structural changes such as a more vertical physis, thinning of the perichondrial ring of La Croix, and reduced stability from the mamillary processes.
SCFE is classified as a Salter-Harris type I fracture showing variable periosteal integrity depending on whether the presentation is acute or chronic. The hypertrophic zone, normally 15 to 30% of the physis, may expand to as much as 80% in affected patients, causing widening of the growth plate. Histological changes include disorganized cartilage maturation, abnormal endochondral ossification, and disruption of the columnar architecture, all of which weaken the physis. Growth-related alterations like the shift of the physis from a horizontal to oblique orientation, combined with femoral neck retroversion or reduced neck-shaft angle, further increase shear stress across the hip. Additional findings including synovitis, irregular collagen fibrils, and accumulation of proteoglycans and glycoproteins, have been observed, though it remains uncertain whether these represent causes or consequences of SCFE.
SCFE cases are mostly idiopathic. There is no history of injury or trauma before the symptom’s onset. A link has found between patients with endocrine disease like hyperthyroidism, hypothyroidism, growth hormone deficiency, panhypopituitarism, Down syndrome, renal disease and development of SCFE. Hypothyroidism is most common etiology of the nonidiopathic SCFE.
Patients who have SCFE who are treated with in situ fixation can do well. In cases with severe slippage and deformity, long term sequalae can occur like osteoarthritis, stiffness, leg length discrepancy, chondrolysis. Conservative methods like treatment, assistive aid, orthotics and analgesics are used for symptomatic relief and then urgent operative care is indicated. Adult patients with loss of motion, unremitting pain and secondary stiffness to chondrolysis, osteoarthritis or AVN can need salvage hip arthrodesis. In cases where hips are incompletely damages, proximal osteotomies can used to redirect the joint force inro damaged area of articular femoral head.
Complications
If left untreated, SCFE can lead to progressive hip deformity, pain, instability of the femoral epiphysis and restricted motion. Major complications include avascular necrosis (AVN) which occurs in up to 47% of unstable cases because of vascular injury at the time of slip or during surgical reduction and often resulting in the eventual need for total hip replacement. Chondrolysis or cartilage destruction leading to joint space narrowing may arise from intra-articular hardware or independent of treatment. Long-term patients are at risk for osteoarthritis specifically in severe slips because of AVN, chondrolysis or altered biomechanics. Additional complications include leg-length discrepancy from AVN, coxa vara or incomplete reduction, hardware-related issues like failure or outgrowth and rarely postoperative infection.
SCFE occurs during adolescence typically between ages 10 to 16 in boys and 12 to 14 in girls with males having a 2.4-fold higher risk. The left hip is more frequently affected and obesity is a key risk factor because of increased shear forces across the proximal growth plate. Clinicians should suspect SCFE in adolescents or young adults presenting with atraumatic hip, thigh or knee pain specifically when accompanied by limping or weight-bearing difficulty. While hip pain is most common (52%), discomfort may also occur in the groin (13.9%), thigh (35%) or knee (26%) with knee pain often referred by the obturator nerve.
Symptoms typically precede diagnosis by 4 to 5 months though onset may be as short as under 3 weeks. Trauma is not usually reported but its presence does not rule out SCFE. Patients may adopt a position of crossing the affected leg over the other. Family history may play a role with 5 to 7% familial involvement and penetrance is variable. In children under 10, SCFE is often linked to metabolic or endocrine disorders like hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy or growth hormone abnormalities and bilateral involvement is more common in these cases.
The disease chronicity must be determined by prodromal symptoms like knee of hip pain, reduced range of motion, limp for < 3 weeks is considered as acute. Prodromal symptoms for > 3 weeks are considered chronic.
Physical examination
The affected extremity may exhibit limited internal rotation and passive internal rotation can lead to discomfort. Internal rotation, abduction and hip flexion can be reduced. The patient may exhibit the Drehmann sign which is required external rotation with the passive hip flexion to 90 degree. The patient can have Trendelenburg, shuffling, total inability to bear the weight or antalgic. Thigh atrophy can or cannot exist.
Osteitis pubis
Groin injury
Femur fracture and injury
Femoral neck stress fracture
Femoral neck fracture
Femoral head avascular necrosis
Treatment paradigm
The treatment paradigm of SCFE is primarily surgical with the approach determined by slip stability, severity and risk of contralateral involvement.
In situ fixation: The standard management for both stable and unstable SCFE is in situ fixation with percutaneous screw placement which aims to prevent further displacement of the epiphysis while minimizing the risk of vascular injury.
The screw should be positioned centrally and perpendicular to the physis under fluoroscopic guidance ensuring at least five threads engage the epiphysis without violating the articular surface. One screw is typically sufficient, though two screws may enhance stability at the expense of a higher complication rate. Postoperatively, patients with stable slips are usually permitted full weight-bearing while those with unstable slips are restricted to partial weight-bearing for about six weeks.
Capsulotomy: Capsulotomy may be performed in unstable cases to reduce intracapsular pressure, although its impact on reducing avascular necrosis (AVN) remains unclear. Prophylactic fixation of the contralateral hip is controversial but may be considered in high-risk groups such as young children, obese males and those with endocrine disorders.
I Modified Dunn Procedure: In severe or unstable SCFE, open reduction and internal fixation via the modified Dunn procedure may be indicated. This technically demanding technique involves surgical hip dislocation, correction of the deformity and fixation of the epiphysis while preserving the femoral head blood supply.
Osteochondroplasty: For patients with residual deformity or femoroacetabular impingement due to metaphyseal prominence, osteochondroplasty may be performed either arthroscopically, through a limited anterior arthrotomy, or with surgical dislocation.
More severe deformities with slip angles exceeding 30 to 45 degrees may necessitate proximal femoral osteotomy, with intertrochanteric, subtrochanteric or femoral neck osteotomies used depending on the degree of correction required.
Postoperative and Rehabilitation Care: Postoperative rehabilitation is essential but poorly standardized in the literature. Recovery typically follows a five-phase program, beginning with inflammation reduction, gait training and early range of motion followed by gradual withdrawal of crutches, progressive strengthening, and aerobic conditioning and culminating in the restoration of functional power for return to daily activity or sport. Ultimately, the treatment of SCFE focuses on stabilizing the slip, preserving femoral head vascularity, correcting residual deformity when necessary and restoring hip function while minimizing long-term complications like AVN, chondrolysis, and osteoarthritis.
Medications
There is no medication is available for SCFE treatment then symptomatic pain relief. This can include nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics or acetaminophen.
Use of Antipyretics/Analgesics to treat SCFE
Pain control is necessary for quality patient care. Analgesics make sure patient comfort. It has sedative properties which is beneficial to patient who has continuous trauma or injuries.
Acetaminophen: It is prescribed to patient who has hypersensitivity to NSAIDS or aspirin with upper gastrointestinal disease or taking other oral anticoagulants.
Acetaminophen and hydrocodone: It is a combination drug which is given during mild to severe pain.
Acetaminophen/codeine (Tylenol): It is prescribed for mild to moderate pain. The dosage form of tylenol is 300 mg acetaminophen/15 or 30 or 60 mg codeine.
Use of NSAIDS to treat SCFE
NSAIDs have anti-inflammatory, analgesic and antipyretic properties. It can inhibit the cyclooxygenase activity and systemises of prostaglandin. Other mechanisms include inhibition of synthesis of leukotriene, lipoxygenase activity, lysosomal enzyme release, neutrophil aggregation and different cell membrane function.
Ibuprofen: It is prescribed during mild to moderate pain. It inhibits the inflammatory reaction and pain by reducing the synthesis of prostaglandin.
Ketoprofen: It is indicated for moderate to mild pain and inflammation. Small dosage in the initially are indicated in elder and small patients and who have liver or renal disease. Dosages more than 75 mg do not elevate therapeutic effects. Administer higher dosage with caution and observe the patient closely.
Naproxen: It is indicated for moderate to mild pain. It inhibits the inflammatory reaction and reducing activity of cyclooxygenase which can lead to reduction of synthesise of prostaglandin.
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A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
