Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs when the ball at the top of the femur (thigh bone) slides out of place from the rest of the bone through the growth plate. It most often affects children and teens during growth spurts. SCFE is a serious condition that needs prompt medical attention. With early diagnosis and proper treatment, most children recover well and return to normal activities.

What Causes SCFE in Children?

SCFE happens when the growth plate in the hip becomes weak and cannot hold the top of the femoral head in its normal position. Risk factors include:

• Rapid growth during puberty
• Excess body weight, which puts extra stress on the hip
• Hormonal or endocrine disorders
• Family history of SCFE
• Certain medical conditions affecting bone strength

SCFE can happen gradually or suddenly after a minor injury. It is important to remember, though, that SCFE can occur even without a trauma or fall, and may happen due to patient or anatomic factors.

What Are the Symptoms?

Symptoms of SCFE can be subtle and may include:

• Hip, groin, thigh, or knee pain
• Limping or a change in walking pattern
• Stiffness or limited motion in the hip
• Difficulty putting weight on the affected leg
• The foot turns outward when walking

Because knee pain is common, SCFE is sometimes mistaken for a knee problem.

When Should My Child See a Specialist?

SCFE is considered an urgent orthopedic condition. You should seek medical care right away if:

• Your child has persistent hip, thigh, or knee pain
• Your child is limping without a clear cause
• Your child cannot put weight on one leg
• Pain suddenly becomes severe

Early treatment can prevent serious long-term complications.

How Is SCFE Diagnosed?

Diagnosis begins with a physical exam and review of symptoms. Imaging studies include:

• X-rays of both hips to confirm the slip
• MRI in select cases to detect early or “pre-slip” changes

These tests help determine the severity and stability of the condition. As above, sometimes patients will localize pain more to the knee than the hip. If a clear cause of discomfort is not known, imaging of both the knee and the hip should be performed to avoid missing this critical diagnosis.

How Is SCFE Treated?

SCFE almost always requires surgery to prevent further slipping. Treatment depends on:

• Whether the slip is stable or unstable
• Severity of the displacement
• Your child’s age and growth stage

Treatment goals focus on:

• Stopping further slippage
• Stabilizing the hip joint
• Preventing complications
• Preserving hip function

Surgical Options

The most common treatment is in-situ fixation, where a screw is placed across the growth plate to hold the femoral head in position while it heals. In more severe cases, additional procedures may be needed to improve hip alignment.

Your child’s surgeon will recommend the safest and most effective approach.

What Are the Risks of Surgery?

As with any surgery, risks may include:

• Infection
• Bleeding
• Damage to blood supply of the hip (rare but serious)
• Hip stiffness
• Need for future surgeries

Your child’s care team will discuss all risks in detail.

What Does Recovery From Treatment Involve?

After surgery, your child will need:

• Limited or no weight-bearing for a period of time
• Crutches or a wheelchair
• Physical therapy to restore strength and motion
• Close follow-up to monitor healing

Parents play an important role in helping children follow activity restrictions.

How Long Does Recovery Take?

Initial healing usually takes 6–8 weeks. Returning to full sports activities may take 3–6 months, depending on the healing process and your child’s progress in therapy.

What Is the Outlook for My Child?

When treated early, the outlook for SCFE is very good. Most children regain normal hip function and return to sports and daily activities. Delayed treatment increases the risk of long-term hip problems, which is why early diagnosis is so important.