Bone, Joint and Muscle Conditions

Slipped Capital Femoral Epiphysis (SCFE)

What is slipped capital femoral epiphysis?

Slipped SCFE. Courtesy of

Normal hip joint (above) and slipped capital femoral epiphysis (below).

Slipped capital femoral epiphysis (SCFE; pronounced “skiffy”) is when the top of the thighbone slips out of place. To understand SCFE, it helps to know a little about what the hip joint looks like.

The top part of the thighbone is shaped like a ball (femoral head). It fits into the hip socket. The ball is connected to the straight part of the thighbone by the growth plate. The growth plate is an area of tissue that is still developing.

In SCFE, the top or cap of the ball slips off the femoral head through the growth plate. Think of the ball as being like a scoop of ice cream that falls off its “cone,” the thighbone. It is a kind of break (fracture).

  • Almost all children with the condition have surgery. Most do well. But some develop problems later due to the condition:

    • One foot might point outward more than the other.
    • One leg may be slightly longer than the other.
    • Blood may stop flowing to the top part of the thighbone.
    • Children’s hips may be stiff, and they may be more likely to develop arthritis at an early age.
    • Children with more severe slips have a greater risk that the fracture will not heal.

  • Both boys and girls get SCFE. They are almost always approaching their teenage years or just into them (adolescents) when the problem occurs. Several other factors can contribute to a child’s chances of having the problem. SCFE is more likely to develop in:

    • Overweight children.
    • Children with a family history of SCFE.
    • Children who have diseases of the endocrine system. Diabetes and Cushing syndrome are examples of endocrine system diseases.
    • Children with kidney failure, thyroid problems or growth hormone abnormalities.

Slipped Capital Femoral Epiphysis at Seattle Children’s

  • Your child will see caregivers who are part of Orthopedics and Sports Medicine. Our orthopedic surgeons have extensive experience in identifying, treating and managing SCFE. We are experts in stabilizing the bone so the thighbone “ball” does not slip any more. We are also leaders in more complicated operations to reposition bones.

    Your child will be cared for by a team of pediatricians, pediatric orthopedic surgeons, nurse practitioners, physician assistants, nurses, athletic trainers, certified medical assistants, registered orthopedic technologists and sports physical therapists. We have the knowledge and experience to give your child expert care, from surgery to follow-up care and rehabilitation. Our caregivers also have special training in the emotional and social needs of young people.

  • Kids are still growing well into their teens. Their bodies can be damaged in ways that an adult body can’t. At Seattle Children’s, we specialize in treating injuries to the bones and joints of children and teenagers who are still growing.

    We understand that in treating any joint problem, we must take into account the stage of your child’s growth plates. These are the areas of growing tissue near the end of each long bone. They determine the size and shape of your child’s bones once your child is grown up.

  • Seattle Children’s has the largest group of board-certified pediatric radiologists in the Northwest. We keep your child’s safety in mind at all times. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image.

    We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

Symptoms of Slipped Capital Femoral Epiphysis

Symptoms of SCFE include:

  • Problems walking
  • Limping
  • Mild pain in the hips, groin or around the knees
  • Severe pain that makes children stop putting weight on the leg that hurts
  • Stiffness in the hip
  • Less movement than usual in the hip

Children may not have had any injury before the pain starts.

Diagnosing Slipped Capital Femoral Epiphysis

When your child comes to our clinic, we examine them. We look for any problems your child has moving their legs and hips, including having pain and less motion than is usual.

Next we take X-rays. If the X-rays look normal, we may ask your child to have an MRI (magnetic resonance imaging) scan of the hip to give us more information.

If your child does have SCFE, we will ask them to stop putting weight on the leg that is affected, even if it does not hurt. This will help lower the chance of more slipping. In most cases, we will have your child stay in the hospital for surgical treatment.

Treating Slipped Capital Femoral Epiphysis

SCFE is a problem that needs urgent attention. If your child has SCFE, they will need surgery so that the ball does not slip off the bone any farther.

  • During surgery for SCFE, the doctor will probably reposition the slip in the hip. Then, the doctor will make a small cut (incision) near your child’s hip. The doctor will put a metal screw through the bone and the growth plate in the cap of the femoral head. This helps make the bone stable.

    Often, children can leave the hospital on the same day as the surgery or on the day after.

    The goal of this first treatment is to stabilize the ball and prevent it from moving any more. We do not try to put the bone back in place. Doing that could create a problem with the blood flow to the ball of the hip joint.

    If the ball position causes problems after your child has healed following surgery, they may need surgery to reposition the ball. This may improve motion and function of their hip.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, second opinion or more information.

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