Slipped Capital Femoral Epiphysis (SCFE)

July 2012 - Donna Magid, M.D., M.Ed.


  • Overweight (2 SD): 1-2/100,000 and increasing
  •  Skeletally immature, peripubertal: M (13-14), F (11-12), age dropping
  • African American: Warm weather (activity?)
  • Male but female catching up: 20-30% bilateral (asynchronous)

Growth spurt is period of greatest risk--rapid growth, weight gain, increasing obliquity of physis.  Malnutrition, endocrine/renal abnormality, developmental dysplastic hip, delayed skeletal maturation may produce atypical cases.

1/2 present w/ hip pain, 1/4 with knee pain. Sx may be subtle, intermittent.


  • Pain
  • Leg length discrepancy- both orthopaedic/functional and cosmetic consequences
  • Limp, gait abnormalities
  • Limited ROM
  • Premature osteoarthritis  


  • Immediate surgical (pin) stabilization through risk period (ie, until skeletal maturity).
  • Reduction ONLY if truly ACUTE (<14-21 days); otherwise treatment worse than natural hx.



  • Decreased height capital epiphysis compared to contralateral
  • Decreased intersection of lateral neck cortex line and lateral epiphysis (neck/head)
  • Physeal asymmetry/widening/irregularity/reaction/lucency or density
  • Osteoporosis symptomatic side  


  • "Ice cream slipped off cone"--head/neck relationship asymmetric
  • Medial-inferior step-off or reaction metaphysis

Always get BOTH hips, both because of asynchronous bilaterality and to enhance appreciation of subtle asymmeteries.

Counsel pt. to return promptly if ‘normal’ side hurts or anyone notices new gait change, limp.

July 2012 - Donna Magid, M.D., M.Ed.