Management and Epidemiology of Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, characterised by posterior and inferior displacement of the capital femoral epiphysis. Peak incidence occurs between 10 and 15 years of age, with a slight male predominance and a strong association with obesity, endocrinopathies and mechanical factors. Diagnosis is often delayed when groin or knee pain is misattributed, resulting in more severe slips and higher complication rates. Epidemiological studies have established excess weight as the principal modifiable risk factor, correlating with bilateral involvement and guiding decisions on prophylactic contralateral fixation. Management stratifies interventions by slip stability and severity. In situ pinning remains the cornerstone for stable slips, yielding low rates of avascular necrosis and chondrolysis. Conversely, severe or unstable slips may necessitate open reduction and internal fixation—such as the modified Dunn procedure—to restore proximal femoral anatomy, albeit with an increased risk of vascular compromise. Contemporary techniques aim to prevent femoroacetabular impingement, thereby reducing the long-term progression to osteoarthritis. Implant choice has evolved towards devices that preserve physeal growth, balancing the benefit of anatomical realignment against potential blood-supply disruption. Ongoing debate surrounds the threshold for prophylactic intervention on the unaffected hip, which is increasingly informed by individual risk profiles.

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Management and Epidemiology of Slipped Capital Femoral Epiphysis publication trend

The graph below shows the total number of articles in management and epidemiology of slipped capital femoral epiphysis across all publications each year (not limited to Nature Index journals).

Technical terms

Slipped capital femoral epiphysis (SCFE): Displacement of the proximal femoral growth plate causing the femoral head to slip relative to the neck.

Pinning in situ: Surgical stabilisation of the slipped epiphysis using percutaneous screws without attempting reduction.

Avascular necrosis: Bone tissue death resulting from interruption of blood supply, a serious complication of unstable slips or aggressive realignment.

Femoroacetabular impingement (FAI): Abnormal contact between the femoral head–neck junction and the acetabular rim, leading to labral and cartilage damage.

Alpha angle: Radiographic measure of femoral head–neck asphericity used to assess impingement and contralateral slip risk.

Prophylactic fixation: Preventive surgical stabilisation of the unaffected hip to reduce the risk of future slip.

Cannulated screw with proximal threading: Implant designed to secure the epiphysis while allowing continued femoral neck growth.

References

1. Slipped capital femoral epiphysis: a population-based study. BMC Musculoskeletal Disorders (2017).
2. Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature. Journal of Children's Orthopaedics (2013).
3. Long-term outcomes of slipped capital femoral epiphysis treated with in situ pinning. Journal of Children's Orthopaedics (2016).
4. Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: A preliminary study. Journal of Children's Orthopaedics (2012).
5. Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis. Journal of Orthopaedics and Traumatology (2017).
6. Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading. Journal of Children's Orthopaedics (2011).
7. The alpha angle as a predictor of contralateral slipped capital femoral epiphysis. Journal of Children's Orthopaedics (2016).
8. Association between body mass index-for-age and slipped capital femoral epiphysis: The long-term risk for subsequent slip in patients followed until physeal closure. Journal of Children's Orthopaedics (2016).