Slipped Capital Femoral Epiphysis (SCFE)

What is slipped capital femoral epiphysis (SCFE)?

2 x-rays, 1 showing a typical hip joint and 1 showing the top of a thighbone that has slipped out of place

Typical hip joint (left) and slipped capital femoral epiphysis (right).

Slipped capital femoral epiphysis (SCFE; pronounced SKIFF-ee) is when the top of the thighbone slips out of place. SCFE is a kind of break (fracture).

To understand SCFE, it helps to know a little about what the hip joint looks like. The top part of the thighbone (femoral head) is shaped like a ball. It fits into the hip socket. The ball is connected to the straight part of the thighbone by the . The growth plate is an area of cartilage where bone is still growing. The part of the thighbone just below the growth plate is called the femoral neck.

In SCFE, the top or cap of the ball slips off the femoral neck through the growth plate. Think of the ball as being like a scoop of ice cream that slips off its “cone,” the thighbone.

Who gets SCFE?

This condition almost always happens when a child is about to enter their teenage years or they just became a teen. It is more likely to happen in:

  • Children who are overweight
  • Children with a family history of SCFE
  • Children with thyroid problems, kidney disease or problems with growth
  • Children who have other diseases of the endocrine system, like diabetes or

Problems from SCFE

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

  • One foot points outward more than the other.
  • One leg is slightly longer than the other.
  • Blood stops flowing to the top part of the thighbone.
  • The hips become stiff, and  starts at an early age.

Children with more severe slips have a greater risk of having hip problems later in life.

Why choose Seattle Children’s for slipped capital femoral epiphysis treatment?

Seattle Children’s Orthopedics and Sports Medicine team provides care for children, teens and young adults with SCFE. Within Orthopedics, experts from our Child and Young Adult Hip Preservation Program are involved to protect or restore your child’s hip function.

  • The hip experts you need are here
    • Your child’s team includes doctors, , and who specialize in children’s bones, muscles and joints. We have decades of experience treating SCFE.
    • Accurate diagnosis is the first step to effective treatment. We involve specialists in . Our team is experienced in making high-quality imaging studies using  and .
    • Our orthopedic surgeons have extensive experience in identifying, treating and managing SCFE. We are experts in stabilizing the bone so the ball of the thighbone does not slip any farther. We are also leaders in more complex operations to change the position of bones.
    • Dr. Todd Blumberg leads the Child and Young Adult Hip Preservation Program. He focuses on treating hip conditions from infancy into adulthood. Blumberg is the only dual fellowship-trained pediatric and hip preservation surgeon in the region. Seattle Children’s does more hip preservation surgeries for young people than any other center in the Pacific Northwest.
    • To help with strength and range of motion after surgery, your child may do physical therapy. We have the largest team of physical therapists in the region who specialize in babies, children, teens and young adults.
  • Our approach to surgery aims to get the best results for your child
    • Before we recommend surgery, we look at your child as a whole person. Your child’s team will take many factors into account. These include how serious their condition is, the effects on their health, how much more they will grow and what results you can expect from treatment.
    • We recommend surgery that we believe will give your child the best results. If your child needs surgery, our surgeons have many years of experience in treating children with SCFE. Each of our hip surgeons is . Many have expanded fellowship training.
    • We have the technology and skills to use imaging to guide hip surgery, if needed. This helps us place hardware, like screws, with precision. It also lets us see in real time the changes we make to the hip. Our operating rooms have the newest, low-dose imaging equipment available.
  • Care from birth through young adulthood
    • We specialize in caring for kids. This means our experts have the knowledge, training and skills to treat the youngest patients, from babies through young adults. Young people need treatment that takes their  into account. Here, your child’s team has special training in the physical, emotional and social needs of young people.
    • Babies, children and teens are still developing. When we evaluate your child’s condition, plan their treatment and provide their care, we carefully consider their growth. We think about how growth may affect their hip over time. We also consider how their hip may affect the rest of their development and health.
    • If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images. We also have the largest group of pediatric radiologists in the Northwest.
  • Support for your whole family
    • Having a child with SCFE can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family.
    • For your convenience, our doctors see patients at locations in Seattle, Bellevue, Everett and Federal Way. We bring high-quality care closer to where you live.
    • Seattle Children’s serves families from around the Northwest and beyond. We can help with financial counseling, education, housing, transportation, interpreter services, spiritual care and more. Our Child Life specialists, Family Resource Center and Guest Services are here to help. Read more about our services for patients and families.
  • Research and advances to improve care
    • Our team members partner with experts around the world on research. Together, they work to understand the causes of hip conditions, improve the accuracy of diagnostic testing and create better surgical approaches.
    • We track long-term results of our patients so we can improve care for young people with hip problems. For example, we ask patients about their experience before and after treatment to make sure our approach improves quality of life and function.
    • Our surgeons have led research to reduce your child’s exposure to radiation from imaging tests, like  and .
    • As part of our constant work to improve results for kids, we developed standard plans (called protocols) to help your child recover after surgery.
    • Learn more about current orthopedics research at Seattle Children’s.

What are the symptoms of slipped capital femoral epiphysis?

Symptoms of SCFE include:

  • Limping or other problems walking.
  • Pain in the hips or groin. Pain may also happen around the knees — sometimes only around the knees in the early stages.
  • Severe pain that makes your child stop putting weight on their leg.
  • Stiffness or less movement than usual in the hip.

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

How is slipped capital femoral epiphysis diagnosed?

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 usual.

Next, we take . If the X-rays look normal, we may ask your child to have an  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 surgery.

How is slipped capital femoral epiphysis treated?

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.

There are several ways to treat SCFE with surgery. Not every slip is the same, so it’s important to get care from specialists in children’s hips who can assess your child’s needs and recommend the best surgery for them. At Seattle Children’s, we are experienced in evaluating each child’s hip and choosing a surgery method to get the best results.

Surgery for slipped capital femoral epiphysis
Four X-rays: X-ray showing a screw that goes through the upper thighbone into the femoral head; X-ray showing a screw that goes through the upper thighbone into the femoral head; 2 x-rays, 1 showing a severe care of the femoral head slipping off the upper thighbone and 1 showing the bone realigned and help in place with 4 screws

Upper left: A screw placed through the upper thighbone to make the femoral head stable and prevent further slipping. Upper right: A special sliding screw that can hold the femoral head in place. It allows for lengthening as your child grows. Severe slip (lower left) and the same hip after surgery to realign the bone and hold it in place with screws (lower right).

The most common method is to make a small cut (incision) near your child’s hip. Then 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, pinning it where it is and keeping it from moving any farther. If the bone has just recently started to slip, doctors may be able to move it back where it was before putting in the screw.

Often, children can leave the hospital the day after this surgery.

Sometimes the bone has already healed in its slipped position by the time a child comes in for diagnosis and treatment. In this case, doctors may not try to put it back where it was because this would mean rebreaking the bone. But there are times when cutting the bone (osteotomy) and realigning it are likely to give your child the best outcome, such as possibly lowering their chance of getting early arthritis in the hip.

Based on your child’s needs, the doctor may be able to do a , or your child may need a larger incision, especially if their slip is more severe.

After surgery, your child may do physical therapy to help with their strength and range of motion.

If the ball position causes problems later, after your child has healed from their initial surgery, they may need another surgery to improve motion and function of their hip.

What to Expect After Treatment

After treatment for SCFE, the doctor will want to see your child and maybe take X-rays until your child is done growing.

Most children have no further problems. But sometimes a child has problems with the hip’s shape or function. Sometimes the slip limited blood flow to the upper part of the femoral head, which may cause some bone there to die (avascular necrosis). Or arthritis may develop in the hip. As your child grows, the ball and socket reshape together, sometimes in ways that don’t lead to easy, pain-free movement.

Your child’s team will check for signs of problems and also make sure you know what signs to watch for and when to call the doctor.

The team from Seattle Children’s Child and Young Adult Hip Preservation Program treats hip problems that might happen after SCFE. We focus on helping children and teens keep their natural hip and delay or avoid hip replacement. We also work with young adults in their 20s who are seeking care. For those who do need an artificial hip, we offer this option as well. Learn more.

Contact Us

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

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