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Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) is an adolescent hip disorder in which the femoral neck displaces anterosuperiorly relative to the capital femoral epiphysis through the proximal femoral physis. It commonly occurs during the growth spurt, especially in overweight adolescents, and may present with hip, groin, thigh, or referred knee pain with a limp. Early diagnosis and stabilization are important to prevent further slip and complications such as avascular necrosis and femoroacetabular impingement.

Slipped Capital Femoral Epiphysis (SCFE) is a disorder of the adolescent hip characterized by displacement through the proximal femoral growth plate. Although it is often described as the femoral head slipping posteroinferiorly, mechanically it is more accurate to consider the femoral neck and metaphysis moving anterosuperiorly while the epiphysis remains within the acetabulum. SCFE most commonly occurs during the adolescent growth spurt and is strongly associated with obesity. Endocrine and metabolic disorders such as hypothyroidism, growth hormone abnormalities, and renal osteodystrophy should be considered, particularly in atypical presentations. Patients may present with hip or groin pain, thigh pain, or isolated knee pain, often associated with a limp. Examination typically demonstrates reduced hip internal rotation, abduction, and flexion. A characteristic finding is obligatory external rotation of the hip during flexion, known as the Drehmann sign. SCFE is clinically classified as stable or unstable according to the patient’s ability to bear weight. Stable slips generally have a better prognosis, while unstable SCFE carries a substantially greater risk of avascular necrosis of the femoral head. Diagnosis is usually made using AP pelvis and lateral hip radiographs. Klein’s line and other radiographic features may help identify the slip. Once SCFE is suspected, the patient should avoid weight bearing to reduce the risk of further displacement. The mainstay of treatment is surgical stabilization, most commonly in-situ screw fixation, to prevent progression of the slip. More complex reconstruction may be required in selected severe deformities. Important complications include avascular necrosis, chondrolysis, residual proximal femoral deformity, femoroacetabular impingement, and early osteoarthritis.

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