Slipped capital femoral epiphysis (SCFE)

Right now, you probably have lots of questions: How serious is slipped capital femoral epiphysis? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Children’s Hospital Boston can explain your child’s condition fully when you meet with us.

Background: the normal hip joint

The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear.

The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

What is SCFE?

Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects teens and, less commonly, kids. In SCFE, the head, or "ball," of the thighbone (referred to as the femoral head) slips off the neck of the thigh bone, much like how a scoop of ice cream can slip off the top of a cone. This condition causes the hip joint to become painful and stiff.
 

What causes slipped capital femoral epiphysis?

In pre-adolescent and adolescent growth and development, a child is growing quickly, as adult hormones begin to circulate in his system. The cartilaginous growth plate (not as strong as bone) gets weaker because it’s broadening. These phenomena, combined with certain anatomical factors, such as the shapes of the femur and the socket, can lead to slippage.

Risk factors that increase the likelihood of SCFE include:

• obesity
• hormonal abnormalities (thyroid, etc.)
• genetic predisposition (runs in families)
• medications, such as steroids
• radiation treatment
• chemotherapy
• bone problems related to kidney disease
   

What are the signs and symptoms of SCFE?

Some signs and symptoms can include:

• pain in the hip that’s aggravated by activity and that may subside with rest
• pain in the groin, thigh or knee in addition to—or instead of—hip pain
• walking with a limp, trouble walking, or feeling like the leg is "giving way"
• walking with a leg turned outward (unilateral slip)
• walking with a waddle (bilateral slip)
• inability to sit with knees straight ahead (knees tend to turn outward)
   

How common is SCFE?

SCFE occurs in about 1 per 1,000 to 1 per 10,000 children and teens.
 

How serious is SCFE?

Slipped capital femoral epiphysis (SCFE) is usually an emergency and must be diagnosed and treated early. Treatment is surgical.

Who’s at risk for developing slipped capital femoral epiphysis?

• SCFE is an unusual condition which is slightly more likely to occur in boys than girls.
• Children ages 12 to 14 years are most at risk.
• SCFE is more prevalent in the northeast region of the United States than in the southwest.
• It is more prevalent among African-Americans.
• In many cases, the child is overweight.
   

How does a doctor diagnose slipped capital femoral epiphysis?

In addition to a complete medical history and physical examination, diagnostic procedures for SCFE may include:

• x-rays
• MRI (magnetic resonance imaging), bone scan, blood tests (rarely needed)
   

How does Children’s treat SCFE?
Specific treatment for SCFE is determined by your child’s doctor based on:

• his age, overall health, and medical history
• the extent and severity of the slip
• expectations for the course of the condition

The goals of treatment are the following:

• prevent the femoral head from further slippage
• eliminate any hip impingement (abnormal jamming of the hip when it’s flexed)

Treatment usually includes:

• surgery (involving the use of a steel screw or pin to hold the femoral head onto the femur to prevent it from slipping further)
• physical therapy (following surgery, to help strengthen the hip and leg muscles)

For details on treatments, see Treatment & Care.

My child’s SCFE is mild. Does he still need treatment?
If a child who has a mild case of SCFE remains relatively pain-free, parents may sometimes be tempted to leave their child’s diagnosed condition untreated. First, untreated slips almost always worsen with time—and unpredictably, the ball may completely slip off. But even if the child grows to adolescence without developing serious pain or a noticeable limp, it’s inevitable that his untreated hip will wear out and become arthritic in adulthood. Parents need to understand that sometimes SCFE treatment in childhood is prophylactic (preventive)—to prevent osteoarthritis or other hip problems later on.

Will my child be OK?

The majority of children treated for SCFE at Children’s have corrections that enable them to walk, play, grow and live active lives. Diagnosing and treating your child’s SCFE early in its development greatly increases the likelihood of a successful outcome.

However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he’s fully grown. Also, the more severe the case, the greater the chance for his hip motion to become limited, his legs to grow to different lengths and for him to have further hip problems in the future.

What new research is Children’s doing regarding developmental hip conditions?

Developmental hip conditions such as slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

The clinical and basic science researchers at Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.

For more on Children’s extensive orthopedic research, see Research & Innovation.

FAQ

Q: What is SCFE?
A: Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects teens and children. A weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate.
 

Q: If my child has SCFE, will he be OK?
A: The majority of children treated for SCFE at Children’s have corrections that enable them to walk, play, grow and live active lives. Treating your child’s SCFE as soon as symptoms develop greatly increases the likelihood of a successful outcome.

However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he’s fully grown. Also, the more severe the case, the greater the chance for his hip motion to become limited, his legs to grow to different lengths and for him to have further hip problems in the future.

Q: What are the signs and symptoms of SCFE?
A: Some signs and symptoms can include:

• pain in the hip that’s aggravated by activity and that may subside with rest
• pain in the groin, thigh or knee in addition to—or instead of—hip pain
• walking with a limp, trouble walking, or feeling like the leg is "giving way"
• walking with a leg turned outward (unilateral slip)
• walking with a waddle (bilateral slip)
• inability to sit with knees straight (knees tend to turn inward)
   

Q: How does Children’s treat SCFE?
A: The goal of treatment is to prevent the femoral head from further slippage. Treatment usually includes:

• surgery (involving the use of a steel screw or pin to hold the femoral head onto the femur to prevent it from slipping further)
• physical therapy (following surgery, to help strengthen the hip and leg muscles)
   

Q: If my child has SCFE, what should I ask my Children’s doctor?
A: Some of the questions you may want to ask include:

• Could you describe what’s wrong with my child’s hip joint?
• Are other tests needed to confirm this diagnosis?
• Is there, or could there be, damage to his tissues or blood vessels?
• Does my child really need treatment for this? What treatment options are there?
• Will SCFE permanently affect his growth plate and the normal growth of his leg?
• How long will it take for him to heal?
• Will he need to use crutches? If so, when, and for how long?
• Will he need rehab or physical therapy?
• Will there be restrictions on my child’s activities? If so, for how long?
• Could there be long-term effects? Pain? Arthritis?
• How long should my child be followed by his care team?
• What can we do at home?
   

Q: How is SCFE usually diagnosed?
A: Besides a complete medical history and physical exam, tests for SCFE may include:

• x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
• MRI (magnetic resonance imaging), bone scan, blood tests (rarely needed)
   

Q: If my child has SCFE in one hip, will he develop it in the other hip, too?
A: In 20 to 40 percent of affected children, SCFE will be present in both hips at the time the child is diagnosed. If only one hip is affected, the other hip will eventually slip 30 to 60 percent of the time.
 

Q: What are the causes and risk factors for SCFE?
A: SCFE is a fracture in growth plates that become weakened as children grow into adolescence through a combination of factors. Risk factors that increase the likelihood of SCFE include:

• obesity
• hormonal problems (thyroid, etc.)
• genetic predisposition (tends to run in families)
• medications, such as steroids
• radiation treatment
• chemotherapy
• bone problems related to kidney disease
   

Q: What’s the long-term outlook for a child who has SCFE?
A: Treating your child’s hip as soon as symptoms develop greatly increases the likelihood of a successful outcome. The majority of children treated for SCFE at Children’s have treatments that enable them walk, play, grow and live active lives.

However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist at least until he’s fully grown. Also, the more severe the case, the greater the chance for limited hip motion, different leg lengths and further hip problems in the future.
 

Q: What is Children’s experience treating hip problems in children and teens?
A: At Children’s, we’re known for our clinical innovations, breakthrough research and leadership in treatment for SCFE and other hip problems. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Children’s own researchers and clinicians.

Adolescents and young adults with hip problems usually need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Children’s Child and Adult Hip Preservation Program is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.
 

Causes

A weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate. Risks for developing the condition include:

• obesity
• hormonal problems (thyroid, etc.)
• genetic predisposition (tends to run in families)
• medications, such as steroids
• radiation treatment
• chemotherapy
• bone problems related to kidney disease
   

Signs and symptoms

Some signs and symptoms of SCFE can include:

• pain in the hip that’s aggravated by activity and that may subside with rest
• pain in the groin, thigh or knee in addition to—or instead of—hip pain
• walking with a limp, trouble walking, or feeling like the leg is "giving way"
• walking with a leg turned outward (unilateral slip)
• walking with a waddle (bilateral slip)
• inability to sit with knees straight (knees tend to turn inward)
   

When to seek medical advice

Contact your child’s doctor is he:

• has pain in the hip that’s aggravated by activity and that may subside with rest
• has pain in the groin, thigh or knee in addition to—or instead of—hip pain
• is walking with a limp, is having trouble walking, or feels as if his leg is "giving way"
• walks with a leg turned outward (unilateral slip)
• walks with a waddle (bilateral slip)
   

Questions to ask your doctor

If your baby or child is diagnosed with SCFE, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns get addressed.

Some of the questions you may want to ask include:

• Could you describe what’s wrong with my child’s hip joint?
• Are other tests needed to confirm this diagnosis?
• Is there, or could there be, damage to his tissues or blood vessels?
• Does my child really need treatment for this? What treatment options are there?
• Will SCFE permanently affect his growth plate and the normal growth of his leg?
• How long will it take for him to heal?
• Will he need to use crutches? If so, when, and for how long?
• Will he need rehab or physical therapy?
• Will there be restrictions on my child’s activities? If so, for how long?
• Could there be long-term effects? Pain? Arthritis?
• What can we do at home?
   

Who’s at risk

Risk factors that increase the likelihood of SCFE include:

• obesity
• hormonal problems (thyroid, etc.)
• genetic predisposition (tends to run in families)
• medications, such as steroids
• radiation treatment
• chemotherapy
• bone problems related to kidney disease
   

Complications

The majority of surgical treatments of SCFE at Children’s occur without major complications. But if left untreated, the condition will eventually become painful, and osteoarthritis (OA) and its attendant problems may result.

Severe cases of SCFE require complex surgeries that involve some risk to the femur’s blood supply and bone health. In rare cases, damage to blood vessels can result in osteonecrosis, or bone death.

Later in life, hip problems can recur, even after successful treatment during childhood. For example, femoral acetabular impingement (FAI) is a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip). FAI is a research topic that Children’s is working on extensively.

For more about research on FAI, see Research & Innovation.
 

Long-term outlook

Children’s extensive research into bone problems means that we can provide your child with the most innovative care available. As a result, the majority of children treated for SCFE at Children’s have corrections that enable them to walk, play, grow and live active lives.

However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he is fully grown. Also, the more severe the case, the greater the chance for limited hip motion, different leg lengths and further hip problems in the future.
 

For teens

If you’re a teen with a developmental hip problem, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you may also be dealing with pain; medical appointments and procedures; and limiting some of your activities for a period of time.

If you’re usually an active person, to be experiencing pain or sitting on the sidelines for a while can be depressing and frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help you. And remember that Children’s Child and Adult Hip Preservation Program is always here for you, too.

Slipped capital femoral epiphysis glossary

• acetabulum: hip socket; a part of the pelvis
   
• arthritis (osteoarthritis): joint inflammation, resulting in pain, swelling, stiffness and limited movement. Arthritis can occur when a joint’s cushioning cartilage wears away.
   
• avascular necrosis (osteonecrosis): a condition in which poor blood supply to a bone leads to bone death; the head of the femur is a common site of this condition
   
• The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
   
• cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move easily without pain
   
• developmental dysplasia of the hip (DDH, hip dysplasia): a spectrum of hip abnormality—ranging from a minor laxity of the ligament that holds the ball in the socket to a complete dislocation, in which the ball is entirely out of the socket.
   
• diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
   
• epiphysis: a secondary bone-forming center at the head (ball) of the femur
   
• femoral acetabular impingement (FAI): a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip).
   
• femoral head: round-headed top of the thigh bone (femur)
   
• femur: the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral head) joins the hip socket (acetabulum) to form the hip joint.
   
• MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body
   
• onset (of signs or symptoms): the first appearance of signs or symptoms
   
• open reduction surgery: a procedure in which the doctor repositions the hip bone into the socket through an incision into the patient’s body
   
• orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the skeletal system, spine and associated muscles, joints and ligaments
   
• orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
   
• osteonecrosis (avascular necrosis): the death of a bone due to loss of blood supply
   
• osteotomy: a surgical procedure that involves cutting a bone
   
• physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
   
• physis: growth plate at the ends of bones
   
• slipped capital femoral epiphysis (SCFE): a hip joint condition in whicha weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate.
   
• x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; to diagnose SCFE, front and side views are usually needed, as well as views of the opposite knee