Slipped Capital Femoral Epiphysis

What is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (SCFE) is one of the most common developmental conditions of the hip joint; it usually affects teens and pre-teens. In SCFE, a weakness of the growth plate (physis, the area at the end of the bone responsible for bone growth) 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.

A SCFE is actually a fracture of the growth plate. The fracture is usually a fairly stable one, and the slippage occurs very slowly. Occasionally, the gradual slippage can become very unstable and the ball can completely slip, leading to severe deformity and even blood supply problems to the “ball.” For this reason, every hip with SCFE should be treated immediately to prevent unstable SCFE.

Here is the difference between a healthy hip and one with slipped capital femoral epiphysis.

What are the symptoms of slipped capital femoral epiphysis?

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)

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 or her system. The growth plate (the area at the end of bone responsible for growth, which is 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.

Slipped capital femoral epiphysis (SCFE) is a rare condition that is slightly more likely to occur in boys than girls. SCFE occurs in about one per 1,000 to one per 10,000 children and teens; children ages 12 to 14 years are most at risk. SCFE is more prevalent in the northeast region of the U.S. than in the southwest and is more prevalent among African-Americans.

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

SCFE is usually an emergency and must be diagnosed and treated early. 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. Treatment is surgical.

How we care for SCFE

The Child and Young Adult Hip Preservation Program at Boston Children's Hospital treats both common and complex hip disorders. As the first program in the country to focus on hip disorders in children and young adults, we are experts in diagnosis and treatment of SCFE and other hip problems.

Patient resources

Download our patient fact sheet for SCFE to learn more about this condition and how the hip specialists in Boston Children’s Child and Young Adult Hip Preservation Program provide comprehensive care throughout each patient’s treatment.