Skip to main content
SpringerLink
Log in

Slipped Capital Femoral Epiphysis: Acute and Chronic

  • Reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

  • 2965 Accesses

Abstract

Slipped capital femoral epiphysis (SCFE) involves displacement of the proximal femoral metaphysis relative to a fixed epiphysis, generally during a period of rapid growth and unique physeal susceptibility. Affected patients have characteristic clinical, histological, and radiologic features that contribute to the displacement. A number of concomitant clinical features and medical diagnoses should heighten a physician’s suspicion of SCFE, prompting appropriate radiologic and laboratory workup. Limp and hip or knee pain in a patient between the ages of 10 and 16 should always include SCFE in the differential until proven otherwise. Once the diagnosis is made, appropriate treatment involves proximal femoral physeal stabilization by a number of surgical methods. The optimal surgical treatment of severe SCFE and its late sequelae remain an evolving and controversial subject.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 599.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Paré A. Cinq Livres De Chirurgie. Wechel; Paris 1572.

    Google Scholar 

  2. Müller E. The classic: 1 on the deflection of the femoral neck in childhood a new syndrome. Clin Orthop Relat Res. 1966;48:7–10.

    Google Scholar 

  3. Whitman RI. Further observations on depression of the neck of the femur in early life; including fracture of the neck of the femur, separation of the epiphysis and simple coxa vara. Ann Surg. 1900;31:145–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Frohelich. Ztschr F Orthop Chir. 1904;12:80.

    Google Scholar 

  5. Key JA. Epiphyseal coxa vara or displacement of the capital epiphysis of the femur in adolescence. J Bone Joint Surg. 1926;8:53–117.

    Google Scholar 

  6. Sprengel. Arch F Klin Chir. 1898;57:805.

    Google Scholar 

  7. Wilson PD. Displacement of upper epiphysis of femur treated by open reduction. J Am Med Assoc. 1924;83:1749–56.

    Article  Google Scholar 

  8. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br. 1957;39-B:358–94.

    CAS  PubMed  Google Scholar 

  9. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953;35-B:442–61.

    CAS  PubMed  Google Scholar 

  10. Wertheimer LG, Lopes Sde L. Arterial supply of the femoral head. A combined angiographic and histological study. J Bone Joint Surg Am. 1971;53:545–56.

    CAS  PubMed  Google Scholar 

  11. Aadalen RJ, Weiner DS, Hoyt W, Herndon CH. Acute slipped capital femoral epiphysis. J Bone Joint Surg Am. 1974;56:1473–87.

    CAS  PubMed  Google Scholar 

  12. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679–83.

    Article  CAS  PubMed  Google Scholar 

  13. Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am. 1986;68:1000–7.

    CAS  PubMed  Google Scholar 

  14. Sankar WN, Brighton BK, Kim YJ, Millis MB. Acetabular morphology in slipped capital femoral epiphysis. J Pediatr Orthop. 2011;31:254–8.

    Article  PubMed  Google Scholar 

  15. Speer DP. The John Charnley award paper. Experimental epiphysiolysis: etiologic models slipped capital femoral epiphysis. Hip. 1982:68–88.

    Google Scholar 

  16. Mirkopoulos N, Weiner DS, Askew M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Paediatr Orthop. 1988;8:268–73.

    Article  Google Scholar 

  17. Ippolito E, Mickelson MR, Ponseti IV. A histochemical study of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1981;63:1109–13.

    CAS  PubMed  Google Scholar 

  18. Sm C, Batterman SC, Brighton CT. Shear strength of the human femoral capital epiphyseal plate. J Bone Joint Surg Am. 1976;58:94–103.

    Google Scholar 

  19. Litchman HM, Duffy J. Slipped capital femoral epiphysis: factors affecting shear forces on the epiphyseal plate. J Pediatr Orthop. 1984;4:745–8.

    Article  CAS  PubMed  Google Scholar 

  20. Ponseti IV, Mcclintock R. The pathology of slipping of the upper femoral epiphysis. J Bone Joint Surg Am. 1956;38-A:71–83.

    CAS  PubMed  Google Scholar 

  21. Tayton K. Does the upper femoral epiphysis slip or rotate? J Bone Joint Surg Br. 2007;89:1402–6.

    Article  CAS  PubMed  Google Scholar 

  22. Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR. An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. J Bone Joint Surg Am. 2013;95:E341.

    Article  PubMed  Google Scholar 

  23. Cd R, Nelson C, Eversman J. Growth hormone levels in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1972;54:1224–6.

    Google Scholar 

  24. Mann DC, Weddington J, Richton S. Hormonal studies in patients with slipped capital femoral epiphysis without evidence of endocrinopathy. J Paediatr Orthop. 1988;8:543–5.

    Article  CAS  Google Scholar 

  25. Burrow SR, Alman B, Wright JG. Short stature as a screening test for endocrinopathy in slipped capital femoral epiphysis. J Bone Joint Surg Br. 2001;83:263–8.

    Article  CAS  PubMed  Google Scholar 

  26. Loder RT, Starnes T, Dikos G. Atypical and typical (idiopathic) slipped capital femoral epiphysis. Reconfirmation of the age-weight test and description of the height and age-height tests. J Bone Joint Surg Am. 2006;88:1574–81.

    Article  PubMed  Google Scholar 

  27. Loder RT, Wittenberg B, Desilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Paediatr Orthop. 1995;15:349–56.

    Article  CAS  Google Scholar 

  28. Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. 1993;13:610–4.

    Article  CAS  PubMed  Google Scholar 

  29. Loder RT, Hensinger RN. Slipped capital femoral epiphysis associated with renal failure osteodystrophy. J Paediatr Orthop. 1997;17:205–11.

    Article  CAS  Google Scholar 

  30. Wolf E, Berdon WE, Cassady JR, Baker DH, Freiberger R, Paviov H. Slipped femoral capital epiphysis as a sequela to childhood irradiation for malignant tumors. Radiology. 1977;125:781–4.

    Article  CAS  PubMed  Google Scholar 

  31. Hirsch PJ, Hirsch SA. Slipped capital femoral epiphysis. Occurrence after treatment with chorionic gonadotropin. JAMA. 1976;235:751.

    Article  CAS  PubMed  Google Scholar 

  32. Stack RE, Peterson LF. Slipped capital femoral epiphysis and Down’s disease. Clin Orthop Relat Res. 1966;48:111–7.

    CAS  PubMed  Google Scholar 

  33. Matava MJ, Patton CM, Luhmann S, Gordon JE, Schoenecker PL. Knee pain as the initial symptom of slipped capital femoral epiphysis: an analysis of initial presentation and treatment. J Pediatr Orthop. 1999;19:455–60.

    Article  CAS  PubMed  Google Scholar 

  34. Kocher MS, Bishop JA, Weed B, Hresko MT, Millis MB, Kim YJ, Kasser JR. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics. 2004;113:E322–5.

    Article  PubMed  Google Scholar 

  35. Kaplan SR, Klinghoffer L. Knee pain in slipped femoral capital epiphysis causing a delay in diagnosis. Am J Surg. 1961;101:798–802.

    Article  CAS  PubMed  Google Scholar 

  36. Cowell HR. The significance of early diagnosis and treatment of slipping of the capital femoral epiphysis. Clin Orthop Relat Res. 1966;48:89–94.

    CAS  PubMed  Google Scholar 

  37. Drehmann F. Drehmann’s sign. A clinical examination method in epiphysiolysis (slipping of the upper femoral epiphysis). Description of signs, aetiopathogenetic considerations, clinical experience (author’s translation). Z Orthop Ihre Grenzgeb. 1979;117:333–44.

    CAS  PubMed  Google Scholar 

  38. Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop Relat Res. 1996;322:8–27.

    PubMed  Google Scholar 

  39. Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Paediatr Orthop. 2006;26:286–90.

    Article  Google Scholar 

  40. Nasreddine AY, Heyworth BE, Zurakowski D, Kocher MS. A reduction in body mass index lowers risk for bilateral slipped capital femoral epiphysis. Clin Orthop Relat Res. 2013;471(7):2137–44.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Hurley JM, Betz RR, Loder RT, Davidson RS, Alburger PD, Steel HH. Slipped capital femoral epiphysis. The prevalence of late contralateral slip. J Bone Joint Surg Am. 1996;78:226–30.

    CAS  PubMed  Google Scholar 

  42. Baghdadi YM, Larson AN, Sierra RJ, Peterson HA, Stans AA. The fate of hips that are not prophylactically pinned after unilateral slipped capital femoral epiphysis. Clin Orthop Relat Res. 2013;471(7):2124–31.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993;75:1134–40.

    CAS  PubMed  Google Scholar 

  44. Klein A, Joplin RJ, Reidy JA, Hanelin J. Roentgenographic features of slipped capital femoral epiphysis. Am J Roentgenol Radium Ther. 1951;66:361–74.

    CAS  PubMed  Google Scholar 

  45. Pinkowsky GJ, Hennrikus W. Klein line on the anteroposterior radiograph is not a sensitive diagnostic radiologic test for slipped capital femoral epiphysis. J Pediatr. 2013;162:804–7.

    Article  PubMed  Google Scholar 

  46. Green DW, Mogekwu N, Scher DM, Handler S, Chalmers P, Widmann RF. A modification of Klein’s line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29:449–53.

    Article  PubMed  Google Scholar 

  47. Wilson PD. The treatment of slipping of the upper femoral epiphysis with minimal displacement. J Bone Joint Surg. 1938;20:379–99.

    Google Scholar 

  48. Steel H. The metaphyseal blanch sign of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1986;68:920–2.

    CAS  PubMed  Google Scholar 

  49. Kallio PE, Paterson DC, Foster BK, Lequesne GW. Classification in slipped capital femoral epiphysis. Sonographic assessment of stability and remodeling. Clin Orthop Relat Res. 1993;294:196–203.

    PubMed  Google Scholar 

  50. Senthi S, Blyth P, Metcalfe R, Stott NS. Screw placement after pinning of slipped capital femoral epiphysis: a postoperative CT scan study. J Pediatr Orthop. 2011;31:388–92.

    Article  PubMed  Google Scholar 

  51. Aronsson DD, Loder RT. Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:99–110.

    Article  PubMed  Google Scholar 

  52. Loder RT, Dietz FR. What is the best evidence for the treatment of slipped capital femoral epiphysis? J Paediatr Orthop. 2012;32 Suppl 2:S158–65.

    Article  Google Scholar 

  53. Zaltz I, Baca G, Clohisy JC. Unstable SCFE: review of treatment modalities and prevalence of osteonecrosis. Clin Orthop Relat Res. 2013;471(7):2192–8.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: an end-result study. J Bone Joint Surg Am. 1965;47:1128–45.

    CAS  PubMed  Google Scholar 

  55. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49:807–35.

    CAS  PubMed  Google Scholar 

  56. Loder RT. Effect of femur position on the angular measurement of slipped capital femoral epiphysis. J Paediatr Orthop. 2001;21:488–94.

    CAS  Google Scholar 

  57. Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997;17:648–54.

    Article  CAS  PubMed  Google Scholar 

  58. Ordeberg G, Hansson LI, Sandstrom S. Slipped capital femoral epiphysis in Southern Sweden. Long-term result with closed reduction and hip plaster spica. Clin Orthop Relat Res. 1987;220:148–54.

    PubMed  Google Scholar 

  59. Heyman CH, Herndon CH. Epiphy seodesis for early slipping of the upper femoral epiphysis. J Bone Joint Surg Am. 1954;36-A:539–55.

    CAS  PubMed  Google Scholar 

  60. Kibiloski LJ, Doane RM, Karol LA, Haut RC, Loder RT. Biomechanical analysis of single- versus double-screw fixation in slipped capital femoral epiphysis at physiological load levels. J Paediatr Orthop. 1994;14:627–30.

    Article  CAS  Google Scholar 

  61. Gourineni P. Oblique in situ screw fixation of stable slipped capital femoral epiphysis. J Pediatr Orthop. 2013;33:135–8.

    Article  PubMed  Google Scholar 

  62. Aronson DD, Loder RT. Slipped capital femoral epiphysis in black children. J Paediatr Orthop. 1992;12:74–9.

    Article  CAS  Google Scholar 

  63. Karol LA, Doane RM, Cornicelli SF, Zak PA, Haut RC, Manoli II A. Single versus double screw fixation for treatment of slipped capital femoral epiphysis: a biomechanical analysis. J Pediatr Orthop. 1992;12:741–5.

    Article  CAS  PubMed  Google Scholar 

  64. Walters R, Simon SR. Joint destruction: a sequel of unrecognised pin penetration in patients with slipped capital femoral epiphysis. In: The hip: proceedings of the eighth open scientific meeting of the Hip Society, St Louis: Mosby 1980:145–64.

    Google Scholar 

  65. Lehman WB, Grant A, Rose D, Pugh J, Norman A. A method of evaluating possible pin penetration in slipped capital femoral epiphysis using a cannulated internal fixation device. Clin Orthop Relat Res. 1984;186:65–70.

    PubMed  Google Scholar 

  66. Seller K, Raab P, Wild A, Krauspe R. Risk-benefit analysis of prophylactic pinning in slipped capital femoral epiphysis. J Pediatr Orthop B. 2001;10:192–6.

    CAS  PubMed  Google Scholar 

  67. Woelfle JV, Fraitzl CR, Reichel H, Nelitz M. The asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis: morbidity of prophylactic fixation. J Pediatr Orthop B. 2012;21:226–9.

    Article  PubMed  Google Scholar 

  68. Sankar WN, Novais EN, Lee C, Al-Omari AA, Choi PD, Shore BJ. What are the risks of prophylactic pinning to prevent contralateral slipped capital femoral epiphysis? Clin Orthop Relat Res. 2013;471:2118–23.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Millis MB, Zaltz I. Emerging concepts in slipped capital femoral epiphysis: editorial comment. Clin Orthop Relat Res. 2013;471(7):2083–4.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Witbreuk MM, Bolkenbaas M, Mullender MG, Sierevelt IN, Besselaar PP. The results of downgrading moderate and severe slipped capital femoral epiphysis by an early imhauser femur osteotomy. J Child Orthop. 2009;3:405–10.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Sink E, Zaltz I, Heare T, Dayton M. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:26–30.

    Article  PubMed  Google Scholar 

  72. Lee CB, Matheney T, Yen YM. Case reports: acetabular damage after mild slipped capital femoral epiphysis. Clin Orthop Relat Res. 2013;471:2163–72.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Clohisy JC, Zebala LP, Nepple JJ, Pashos G. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am. 2010;92:1697–706.

    Article  PubMed  Google Scholar 

  74. Leunig M, Horowitz K, Manner H, Ganz R. In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop Relat Res. 2010;468:3160–7.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol. 2007;19:389–410.

    Article  PubMed  Google Scholar 

  76. Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467:704–16.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Sankar WN, Vanderhave KL, Matheney T, Herrera-Soto JA, Karlen JW. The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective. J Bone Joint Surg Am. 2013;95:585–91.

    Article  PubMed  Google Scholar 

  78. Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92:2898–908.

    Article  PubMed  Google Scholar 

  79. Huber H, Dora C, Ramseier LE, Buck F, Dierauer S. Adolescent slipped capital femoral epiphysis treated by a modified Dunn osteotomy with surgical hip dislocation. J Bone Joint Surg Br. 2011;93:833–8.

    Article  CAS  PubMed  Google Scholar 

  80. Maeda S, Kita A, Funayama K, Kokubun S. Vascular supply to slipped capital femoral epiphysis. J Pediatr Orthop. 2001;21:664–7.

    CAS  PubMed  Google Scholar 

  81. Waldenstrom H. On necrosis of the joint cartilage by epiphyseolysis capitis femoris. Clin Orthop Relat Res. 1930;1996:3–7.

    Google Scholar 

  82. Kennedy JP, Weiner DS. Results of slipped capital femoral epiphysis in the black population. J Pediatr Orthop. 1990;10:224–7.

    Article  CAS  PubMed  Google Scholar 

  83. Rooks MD, Schmitt EW, Drvaric DM. Unrecognized pin penetration in slipped capital femoral epiphysis. Clin Orthop Relat Res. 1988;234:82–9.

    PubMed  Google Scholar 

  84. Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–5.

    Article  CAS  PubMed  Google Scholar 

  85. Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. 1981;63:85–95.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, William Beaumont Hospital, 30575 Woodward Avenue, Royal Oak, MI, 48073, USA

    Ira Zaltz

  2. Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA

    Andrew G. Georgiadis

Authors
  1. Ira Zaltz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew G. Georgiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ira Zaltz .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane J. Nho

  2. Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, Switzerland

    Michael Leunig

  3. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher M. Larson

  4. Department of Orthopaedics, University of Michigan, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Sports Medicine and Shoulder Service and Center for Hip Preservation Surgery, Hospital for Special Surgery, New York, New York, USA

    Bryan T. Kelly

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this entry

Cite this entry

Zaltz, I., Georgiadis, A.G. (2015). Slipped Capital Femoral Epiphysis: Acute and Chronic. In: Nho, S., Leunig, M., Larson, C., Bedi, A., Kelly, B. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6965-0_36

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6965-0_36

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6964-3

  • Online ISBN: 978-1-4614-6965-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation