What is it?
The hip joint is made up of a ball and socket. Slipped capital femoral epiphysis, or SCFE, is a condition primarily seen in older children and adolescents where the growth plate within the ball is weakened and causes the two ends to slip off. This has often been compared to how a scoop of ice cream might slip off of a cone. Sometimes, this can happen suddenly, after a fall or sports injury for example, or it can happen over time without any previous history of injury.

Causes
Slipped capital femoral epiphysis may occur after a sudden injury to the hip as seen after a fall or a sports activity, or can occur slowly over time without an injury.

Risk Factors
• Obesity (carrying extra weight puts increased pressure on the growth plate) • A family history of slipped capital femoral epiphysis • A history or family history of endocrine conditions such as diabetes, thyroid disease, or growth hormone problems. • Use of some medications, like steroids.

Symptoms
• Pain of one or both hips. • The pain is often located within the groin or outside part of the hip. • Pain may also be located on the thigh down to the knee. • There may be a limp with walking or running.

Diagnosis
The diagnosis of slipped capital femoral epiphysis is made by history, physical exam, and x-rays of both hips.

Treatment
• Slipped capital femoral epiphysis is treated with surgery to stabilize the slipped bone. • Prior to surgery, rest is often recommended with the use of crutches to avoid putting further weight on the affected leg. • Depending on the age of the child, the other hip may be fixed even without symptoms or x-rays showing slippage.

Injury Prevention
Weight loss may help reduce the risk of slipped capital femoral epiphysis in overweight individuals.

Return to Play
Depending on the severity of the slippage, most children may return to sports about 6 months after an operation to treat a slipped capital femoral epiphysis. Some contact and collision sports may be restricted, especially in children with more severe cases.

AMSSM Member Authors
Mark Riederer, MD and Neeru Jayanthi, MD

References
Anderson SJ and Harris S, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010.

Bittersohl B, Hosalkar HS, Zilkens C, Krauspe R. Current concepts in management of slipped capital femoral epiphysis. Hip Int. 2014 Oct 19:0. doi: 10.5301/hipint.5000189. [Epub ahead of print]