Summary
Definition
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis.
SCFE is a misnomer; it is the metaphysis that displaces anteriorly and superiorly, leading to the slipped state.[1][2] Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy. A period of rapid growth in adolescence may also weaken the epiphyseal plate.[1] Klein lines are drawn along the superior cortex of the femoral neck. Plain anteroposterior/frog-leg lateral radiographs show the Klein line not intersecting the femoral head in hips with SCFE. Valgus SCFE is defined as posterolateral slippage of the proximal femoral epiphysis on the metaphysis.[3][Figure caption and citation for the preceding image starts]: Klein lines are drawn along the superior cortex of the femoral neck. A normal Klein line will intersect the epiphysis. An abnormal Klein line does not intersect the epiphysis, as the femoral neck has moved proximally and anteriorly relative to the epiphysisImage courtesy of John M. Flynn, MD [Citation ends].
History and exam
Key diagnostic factors
- presence of risk factors
- weight (>90th percentile)
- gait with affected leg externally rotated
Other diagnostic factors
- groin or knee pain
- bilateral hip pain
- Trendelenburg's gait
- restricted range of motion
- weight (<50th percentile)
- symptoms of hypothyroidism or panhypopituitarism
- renal failure
- recent trauma
Risk factors
- puberty
- obesity
- male sex
- endocrine disorders
- vitamin D deficiency
- ancestry
- geographic region
- prior radiotherapy
Diagnostic investigations
1st investigations to order
- bilateral antero-posterior x-rays
- frog-leg lateral x-rays
Investigations to consider
- metabolic panel
- serum thyroid function tests
- serum growth hormone
Treatment algorithm
unstable SCFE
stable SCFE
late deformity
Contributors
Authors
Jonathan Wright, MBBS, FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Catterall Unit, Department of Paediatric Orthopaedics
Royal National Orthopaedic Hospital
Stanmore
London
UK
Disclosures
JW is an author of a reference cited in this topic.
Neil Segaren, MBBS, FRCS
Consultant Orthopaedic Surgeon
Catterall Unit, Department of Paediatric Orthopaedics
Royal National Orthopaedic Hospital
Stanmore
London
UK
Disclosures
NS declares that he has no competing interests.
Acknowledgements
Mr Jonathan Wright and Mr Neil Segaren would like to gratefully acknowledge Dr Randall T. Loder, Dr John M. Flynn, Dr Purushottam A. Gholve, Dr Danielle B. Cameron, and Dr Patrick O'Toole, previous contributors to this topic.
Disclosures
RTL receives book royalties and performs legal consultancy. RTL is an author of a number of references cited in this topic. JMF, PAG, DBC, and PO declare that they have no competing interests.
Peer reviewers
James McCarthy, MD, FAAOS, FAAP
Associate Professor
Department of Orthopedics and Rehabilitation
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
JM declares that he has no competing interests.
D. Philip Thomas, MB, BS, FRCS
Consultant Orthopaedic Surgeon and Honorary Lecturer
University Hospital of Wales
Cardiff
UK
Disclosures
DPT declares that he has no competing interests.
Nicholas M. Clarke, ChM, FRCS
Professor
Consultant Orthopaedic Surgeon
Developmental Origins of Health and Disease (DOHaD)
School of Medicine
University of Southampton
Southampton
UK
Disclosures
NMC has received honoraria for visiting professorships in North America and also for lectures in respect of congenital hip dysplasia. He is also a founding member of the International Hip Dysplasia Institute, which has received charitable funding.
References
Key articles
Perry DC, Arch B, Appelbe D, et al. The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain. Bone Joint J. 2022 Apr;104-B(4):519-28.Full text Abstract
Aprato A, Conti A, Bertolo F, et al. Slipped capital femoral epiphysis: current management strategies. Orthop Res Rev. 2019;11:47-54.Full text Abstract
Sucato DJ. Approach to the hip for SCFE: the North American perspective. J Pediatr Orthop. 2018 Jul;38 Suppl 1:S5-12.Full text Abstract
Wright J, Ramachandran M. Slipped capital femoral epiphysis: the European perspective. J Pediatr Orthop. 2018 Jul;38 Suppl 1:S1-4.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hip fractures
- Avascular necrosis
- Legg-Calve-Perthes' disease
More DifferentialsGuidelines
- Open reduction of slipped capital femoral epiphysis
More Guidelines
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