Highlights & Basics
- Slipped capital femoral epiphysis may present with an acute/insidious onset of pain and limp.
- The disorder is typically seen in the adolescent age group.
- Associated systemic disease may be present.
- Obligatory external rotation on hip flexion is a key examination finding.
- Recommended surgical treatment is in situ pinning; prophylactic fixation of the contralateral hip may be necessary when concomitant metabolic disease is present.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
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 epiphysis
Unstable SCFE of the right hip. Anteroposterior preoperative radiograph
Unstable SCFE of the right hip. Frog-leg lateral preoperative radiograph
Unstable SCFE of the right hip fixed with 2 screws. Left hip prophylactic fixation with a single screw. Anteroposterior postoperative radiograph
Unstable SCFE of the right hip fixed with 2 screws. Left hip prophylactic fixation with a single screw. Frog-leg lateral postoperative radiograph
Citations
Loder RT. Controversies in slipped capital femoral epiphysis. Clin Orthop North Am. 2006 Apr;37(2):211-21.[Abstract]
Lehmann CL, Arons RR, Loder RT, et al. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. 2006 May-Jun;26(3):286-90.[Abstract]
Lowndes S, Khanna A, Emery D, et al. Management of unstable slipped upper femoral epiphysis: a meta-analysis. Br Med Bull. 2009;90:133-46.[Abstract]
Raney EM, Freccero DM, Dolan LA, et al. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop. 2008 Oct-Nov;28(7):701-4.[Abstract]
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7. Loder RT, Richards BS, Shapiro PS, et al. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993 Aug;75(8):1134-40.[Abstract]
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24. Loder RT, Greenfield ML. Clinical characteristics of children with atypical and idiopathic slipped capital femoral epiphysis: description of the age-weight test and implications for further diagnostic investigation. J Pediatr Orthop. 2001 Jul-Aug;21(4):481-7.[Abstract]
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29. Ziebarth K, Zilkens C, Spencer S, et al. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009 Mar;467(3):704-16.[Abstract][Full Text]
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31. Davis RL 2nd, Samora WP 3rd, Persinger F, et al. Treatment of Unstable Versus Stable Slipped Capital Femoral Epiphysis Using the Modified Dunn Procedure. J Pediatr Orthop. 2019 Sep;39(8):411-415.[Abstract][Full Text]
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33. Lowndes S, Khanna A, Emery D, et al. Management of unstable slipped upper femoral epiphysis: a meta-analysis. Br Med Bull. 2009;90:133-46.[Abstract]
34. Gage JR, Sundberg AB, Nolan DR, et al. Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis. J Bone Joint Surg Am. 1978 Mar;60(2):157-65.[Abstract]
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37. Park S, Hsu JE, Rendon N, et al. The utility of posterior sloping angle in predicting contralateral slipped capital femoral epiphysis. J Pediatr Orthop. 2010 Oct-Nov;30(7):683-9.[Abstract]
38. National Institute for Health and Care Excellence. Open reduction of slipped capital femoral epiphysis. Jan 2015 [internet publication].[Full Text]
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40. Sink EL, Zaltz I, Heare T, et al. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop. 2010 Jan-Feb;30(1):26-30.[Abstract]
41. Ziebarth K, Domayer S, Slongo T, et al. Clinical stability of slipped capital femoral epiphysis does not correlate with intraoperative stability. Clin Orthop Relat Res. 2012 Aug;470(8):2274-9.[Abstract]
42. Sankar WN, McPartland TG, Millis M, et al. The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis. J Pediatr Orthop. 2010 Sep;30(6):544-8.[Abstract]
43. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009 Jan-Feb;29(1):1-8.[Abstract]
44. Palocaren T, Holmes L, Rogers K, et al. Outcome of in situ pinning in patients with unstable slipped capital femoral epiphysis: assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010 Jan-Feb;30(1):31-6.[Abstract]
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46. Peterson MD, Weiner DS, Green NE, et al. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997 Sep-Oct;17(5):648-54.[Abstract]
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49. Palocaren T, Holmes L, Rogers K, et al., Outcome of in situ pinning in patients with unstable slipped capital femoral epiphysis: assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010 Jan-Feb;30(1):31-6.[Abstract]
50. American College of Radiology. ACR Appropriateness Criteria. Osteonecrosis. 2022 [internet publication].[Full Text]
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52. Raney EM, Freccero DM, Dolan LA, et al. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop. 2008 Oct-Nov;28(7):701-4.[Abstract]
