SLIPPED CAPITAL FEMORAL EPIPHYSIS

@patrick macharia MKU

• Slipped capital femoral epiphysis (SCFE or
skiffy, slipped upper femoral
epiphysis, SUFE or souffy, coxa vara
adolescentium)
• is a medical term referring to a fracture
through the growth plate (physis), which
results in slippage of the overlying end of the
femur (metaphysis).

@patrick macharia MKU

 Slipped capital femoral epiphysis

• (SCFE) is one of the most important pediatric

and adolescent hip disorders encountered in
medical practice. 
• Although SCFE is a rare condition, an accurate
diagnosis combined with immediate
treatment is critical. 

@patrick macharia MKU

 epidemiology
• The overall incidence for SCFE in the United
States is 10.8 cases per 100,000 children. 
• The incidence rate in boys (13.35 per 100,000)
is higher than in girls (8.07 per 100,000). 

@patrick macharia MKU

 Functional anatomy
• the epiphyseal growth plate is unusually
widened, primarily due to expansion of the
zone of hypertrophy. 

@patrick macharia MKU

 PRESENTATION
• Slipped capital femoral epiphysis (SCFE) is most
common in the adolescent period (ie, boys aged
10-16 y, girls aged 12-14 y). Males have 2.4
times the risk compared with females.
• The left hip is affected more commonly than the
right.
• Obesity is a risk factor because it places more
shear forces around the proximal growth plate
in the hip at risk.
@patrick macharia MKU
₫ Prodromal symptoms (eg, hip or knee pain, limp, decreased
range of motion) for less than 3 weeks are deemed acute.
₫ Prodromal symptoms for longer than 3 weeks are deemed
chronic.
₫ Determine if a traumatic episode occurred.
₫ It is important to determine if the lesion is stable or unstable.
₫ "Stable" SCFEs allow the patient to ambulate with or without
crutches. 
₫ "Unstable" SCFEs do not allow the patient to ambulate at all;
these cases carry a higher rate of complication, particularly of
AVN.

@patrick macharia MKU

 Physical findings
₾ If a patient reports knee pain, always examine the hip, because
knee pain may be referred pain from the hip via the obturator
nerve.
₾ Obesity increases a clinician's index of suspicion for SCFE.
₾ Patients often hold their affected hip in passive external rotation.
₾ Determine the patient's ability to bear weight (stable vs unstable).
₾ If the patient is ambulatory, determine the his or her gait pattern:
₾ Antalgic – Shortened stance phase on the affected side
₾ Out-toeing

@patrick macharia MKU

 Cont...
₻ Always examine both hips.
₻ Assess the active and passive range of motion in both hips.
₻ Internal and external rotation are best tested with the
patient in the prone position with the knees flexed to 90 º.
₻ If SCFE is present, the lower extremity may externally
rotate and abduct with gentle passive hip flexion.
₻ Internal rotation is decreased in nearly all hips with SCFE.
₻ Internal rotation is often painful.

@patrick macharia MKU

 Differential Diagnoses

• Femoral Head Avascular Necrosis

• Femoral Neck Fracture
• Femoral Neck Stress Fracture
• Femur Injuries and Fractures
• Groin Injury

@patrick macharia MKU

 workup
• Appropriate laboratory tests should be
completed for endocrinopathies and medical
disorders (hypothyroidism, low growth
hormone level, pituitary tumors,
craniopharyngioma, Down syndrome, renal
osteodystrophy,

@patrick macharia MKU

 Imaging Studies
• Obtain anteroposterior and frog-lateral
radiographs of the pelvis or bilateral hips.
• Determine the amount of head displacement
off the femoral neck as a percentage to
classify the degree of slippage.
– Type I slippage is less than 33% displacement.
– Type II slippage is between 33% and 50%
displacement.
– Type III slippage is greater than 50% displacement.

@patrick macharia MKU

 Cont....
• Note any bony changes of the femoral neck
and head because they may demonstrate
chronic adaptive changes during alterations in
hip biomechanics as the femoral head
displaces.

@patrick macharia MKU

AP radiograph: The Klein line is drawn straight up the superior
aspect of the femoral neck. This should intersect the epiphysis. If
not, then it is likely an SCFE

@patrick macharia MKU

 management
• Acute Phase
Medical Issues/Complications
• Treatment of slipped capital femoral epiphysis
(SCFE) is emergent; therefore, early and
accurate diagnosis is paramount. 

@patrick macharia MKU

 Surgical Intervention

immediate internal fixation in-situ using a single

cannulated screw is the treatment of choice of
SCFE.
Fixation allows early stabilization of the slippage,
enhancement of physeal closure, prevention
of further slippage

@patrick macharia MKU

 Cont...
• Unstable or grade III slips may require gentle
repositioning to improve alignment.
• Revision of the screw fixation may be needed
if the child "outgrows" the screw, placing the
child at risk for a repeat slip.

@patrick macharia MKU