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Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis is a topic covered in the 5-Minute Emergency Consult.

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  • Femoral epiphysis translates (slips) posteriorly and inferiorly relative to the femoral head/neck
  • Classification systems:
    • Degree of femoral head “slip” as a percentage of femoral neck diameter:
      • (Mild, grade 1) <33.3%
      • (Moderate, grade 2) 33.3–50%
      • (Severe, grade 3) >50%
    • Temporal:
      • Acute: <3 wk of symptoms
      • Chronic: >3 wk of symptoms
      • Acute on chronic: >3 wk of symptoms, now with acute pain
    • Stability:
      • Stable: Bears weight w/or w/o crutches
      • Unstable: Unable to bear weight
  • Epidemiology:
    • Peak age: 12–14 yr (boys), 11–12 yr (girls)
    • Male > female (1.6:1)
    • Bilateral slips: 20% at presentation; additional 20–40% progress to bilateral
    • Atypical SCFE: Endocrinopathy associated:
      • Patient may be <10 yr age, >16 yr age, or weight <50th percentile
      • High risk of bilateral SCFE (up to 100%)


  • Proximal physis position changes in adolescence from horizontal to oblique; hence hip forces shift from “compression” to “shear”
  • Shear force > strength of femoral physis
  • Weakest point of physis = zone of hypertrophy
  • Risk factors:
    • Obesity: May contribute to shear forces
    • Down syndrome
    • Endocrinopathy such as hypothyroidism, growth hormone deficiency, renal osteodystrophy (2° hyperparathyroidism): May contribute to growth plate weakening

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Rosen, Peter, et al., editors. "Slipped Capital Femoral Epiphysis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis.
Slipped Capital Femoral Epiphysis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis. Accessed April 25, 2019.
Slipped Capital Femoral Epiphysis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis
Slipped Capital Femoral Epiphysis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Slipped Capital Femoral Epiphysis ID - 307398 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -