Slipped capital femoral epiphysis

Last updated: November 1, 2023

Summarytoggle arrow icon

Slipped capital femoral epiphysis (SCFE) refers to the superior and anterolateral displacement of the femoral neck due to weakening of the proximal femoral epiphyseal growth plate. The name of the condition is a misnomer because the metaphysis, not the epiphysis, is displaced. It most commonly occurs in adolescent boys. The etiology is not fully understood, but risk factors include obesity and endocrine disorders. SCFE may have an acute or insidious onset and manifests with hip pain, limping, and restricted movement of the affected hip. If the patient is unable to walk, then the SCFE is considered unstable, which increases the risk of complications such as avascular necrosis. Conventional x-ray confirms the displacement. Surgical fixation is the only treatment option.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

The exact etiology is still unknown. However, there are some risk factors that increase the likelihood of SCFE: [2]

Pathophysiologytoggle arrow icon

In SCFE, the metaphysis is displaced, not the epiphysis.

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

  • Imaging [1][6]
    • Modality
    • Findings
      • Widening of the joint space
      • The femoral head appears to be displaced posteriorly and inferiorly relative to the femoral neck.
      • Klein line not passing the femoral head: It is a straight line drawn along the superior border of the femoral neck that normally passes through the femoral head.
      • Frog leg projection line not passing the femoral head: It is a line drawn through the center of the epiphysis that normally should pass through the center of the femoral neck.
      • Southwick method (for measurement of the slip angle/severity): refers to the tilt of the femoral neck in relation to the femoral head
      • Rules out underlying medical conditions (e.g., rickets)
      • Determines degree of displacement
  • Laboratory tests: to exclude endocrinopathies in patients with an atypical age of onset or short stature

To visualize the displacement of the femoral head relative to the femoral neck as seen on x-ray, imagine a scoop of ice cream slipping from its cone.

Treatmenttoggle arrow icon

Differential diagnosestoggle arrow icon

Snapping hip syndrome [7]

The differential diagnoses listed here are not exhaustive.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Witbreuk M, van Kemenade FJ, van der Sluijs JA, Jansma EP, Rotteveel J, van Royen BJ. Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature. J Child Orthop.. 2013; 7 (3): p.213-223.doi: 10.1007/s11832-013-0493-8 . | Open in Read by QxMD
  2. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped Capital Femoral Epiphysis: Current Concepts. J Am Acad Orthop Surg. 2006; 14 (12): p.666-679.doi: 10.5435/00124635-200611000-00010 . | Open in Read by QxMD
  3. Perry DC, Metcalfe D, Lane S, Turner S. Childhood Obesity and Slipped Capital Femoral Epiphysis. Pediatrics. 2018; 142 (5): p.e20181067.doi: 10.1542/peds.2018-1067 . | Open in Read by QxMD
  4. Riad J, Bajelidze G, Gabos PG. Bilateral Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics. 2007; 27 (4): p.411-414.doi: 10.1097/01.bpb.0000271325.33739.86 . | Open in Read by QxMD
  5. Kamegaya M, Saisu T, Nakamura J, Murakami R, Segawa Y, Wakou M. Drehmann sign and femoro-acetabular impingement in SCFE.. J Pediatr Orthop. 2011; 31 (8): p.853-7.doi: 10.1097/BPO.0b013e31822ed320 . | Open in Read by QxMD
  6. Peck D. Slipped Capital Femoral Epiphysis: Diagnosis and Management. Am Fam Physician. 2010; 82 (3): p.258-262.
  7. Piechota M, Maczuch J, et al. Zespół trzaskającego biodra w dynamicznym badaniu ultrasonograficznym. Journal of Ultrasonography. 2016; 16 (66): p.296-303.doi: 10.15557/jou.2016.0030 . | Open in Read by QxMD
  8. Leunig M, Casillas MM, Hamlet M, et al. Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000; 71 (4): p.370-375.doi: 10.1080/000164700317393367 . | Open in Read by QxMD

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