Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is an unusual disorder of the adolescent hip. For reasons that are not well understood, the ball at the upper end of the femur (thigh bone) slips off in a backward direction. This is due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.

The condition is diagnosed based on a careful history, physical examination, observation of the gait/walking pattern, and X-rays of the hip. The X-rays help confirm the diagnosis by demonstrating that the upper end of the thigh bone does not line up with the portion called the femoral neck.


  • History of several weeks or months of hip or knee pain and an intermittent limp.
  • He or she walks with a limp.
  • Will be unable to bear any weight on the affected leg in severe cases.
  • The affected leg is usually turned outward in comparison to the normal leg.
  • The affected leg may appear to be shorter.


The goal of treatment, which requires surgery, is to prevent any additional slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited. Premature osteoarthritis could develop. Treatment should be immediate. In most cases, treatment begins within 24 to 48 hours. Early diagnosis of SCFE provides the best chance to achieve the treatment goal of stabilizing the hip. Fixing the femoral head with pins or screws has been the treatment of choice for decades.

Depending on the severity of he child's condition, the surgeon will recommend one of three surgical options.

  • Placing a single screw into the thighbone and femoral epiphysis.
  • Reducing the displacement and placing one or two screws into the femoral head.
  • Removing the abnormal growth plate and inserting screws to aid in preventing any further displacement.

Pediatric Orthopedics