Slipped Capital Femoral Epiphysis: Symptoms, Causes & Treatment

Slipped capital femoral epiphysis is a condition affecting the hip joint in children and adolescents during rapid growth (often between 10 and 16 years). In it, the head of the femur (the upper ball part) slips off its position at the not-yet-complete cartilage growth plate, deviating backward and downward, just as a scoop of ice cream may slip off its cone. It is among the most important hip disorders at this age.

Its likelihood increases with factors such as obesity (the most associated), the growth spurt, and some hormonal disorders. Symptoms often appear gradually and include hip or thigh pain, and the pain is often in the knee (referred pain) so it is misunderstood and diagnosis delayed, in addition to a limp and altered gait, the foot turning outward, and limited hip movement. The condition may be sudden and acute after a minor injury, or chronic developing over weeks.

This condition is a near-surgical emergency in most cases: once diagnosed (by hip X-ray), it is often advised not to bear weight on the leg and to have prompt surgical intervention to fix the femoral head in place with a screw or pins to prevent further slipping. The importance of speed lies in the fact that delaying treatment or continuing to walk may increase the slip and raise the risk of a serious complication, namely death of the femoral-head tissue (avascular necrosis) or joint stiffness. Because the condition may later affect the other hip, both sides are monitored. Therefore, any hip or knee pain and limping in an adolescent, especially with obesity, deserves urgent evaluation.

• Pain in the hip or thigh, often in the knee (referred pain).
• A limp and altered gait.
• The foot turning outward and limited hip movement.
• Difficulty bearing weight in acute cases.

• Weakness of the cartilage growth plate in the hip during rapid growth.
• Obesity (the most associated factor).
• The adolescent growth spurt and some hormonal disorders.

• Clinical examination of the hip, gait, and range of motion.
• Hip X-ray (from two angles) to confirm the slip and its degree.
• Assessing the other hip for possible involvement.

Urgent intervention

• Not bearing weight on the leg as soon as it is suspected.
• Prompt surgery to fix the femoral head with a screw or pins to prevent further slipping.

Follow-up

• Monitoring the other hip for possible involvement, and sometimes fixing it preventively in selected cases.
• Managing obesity and accompanying factors.

This content is educational and does not replace consulting a pediatric orthopedic specialist; the condition is a near-emergency.

• Death of the femoral-head tissue (avascular necrosis).
• Joint stiffness and early arthritis.
• Increased slip and permanent deformity with delayed treatment.

• Managing obesity in children and adolescents.
• Not neglecting hip or knee pain and limping in an adolescent.
• Early diagnosis and intervention to prevent complications.