- Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs primarily in children going through puberty, with boys more commonly affected than girls. The left hip is more likely to slip than the right, and there is a 25-40% risk of the other hip slipping as well if one side slips. - SCFE occurs when the femoral head slips through the growth plate of the hip. Common causes include hormonal imbalances during puberty, thinning of the retaining ring around the growth plate, and trauma. Clinically, patients present with thigh or knee pain, the leg externally rotated and shortened. Imaging shows displacement of the femoral head. - SCFE is

1. *

4. * It is uncommon and virtually confined to
children going through pubertal growth spurt.
*The left hip is affected more than the right and
if one side slips there is a 25-40 percent risk of
the other side also slipping.
*Boys are more affected than girls

5. *Etiology :
Slip occur through the hypertrophic zone of the cartilaginous
growth plate .
1. Theory of Hormonal imbalance ( pituitary hormone and gonadal
hormone )
1. Perichondrial ring thinning (retaining collar around the physis)
2. Trauma ( specially acute slip)

6. *PATHOLOGY :
In slipped epiphysis the femoral shaft rolls into external
rotation and the femoral neck displaced forward while the
epiphysis remain seated in the acetabulum .
The disruption occur through the hypertrophic zone of the
physis and relatively speaking the physis is slips posteriorly
on the femoral neck.

8. *CLINICAL FEATURES :
-The patient is usually a child around puberty typically
overweight or very tall and thin .
-The presenting symptoms include pain sometimes in the groin
but often only in the thigh or knee , which can be misleading.
It may be called a “sprain” .
-Sometimes the child become aware that the leg is “ turning
out”.
-On examination the leg is externally rotated and is 1-2 cm
short .
-The classic sign is the tendency to increasing external rotation
as the hip is flexed.

9. 11 year-old-boy with unstable SCFE . His affected leg is turned outward and
is shorter than the other leg .

10. *IMAGING :
1- Anteroposterior view : Trethowan’s sign ( klein line)

11. *IMAGING :
1- Anteroposterior view : metaphyseal blanch sign of steel.

12. *IMAGING :
2- Frog-leg Lateral view :

13. *IMAGING :
2- Frog-leg Lateral view : Southwick Angle Classification .

14. *Grading
1) timing of onset classification :
A- Pre-slip
groinknee pain on exertion , usually normal examination.
B- Acute slip
symptoms less than 3 weeks with external rotation deformity , shortening
and limitation of rotational movement.
C- Chronic slip
Pain in the grointhigh or knee lasting more than 3 weeks . Loss
of internal rotation , limb shortening.
D- Acute-on-Chronic
long history and an acute , severe exacerbations

15. *Grading
2) Radiological Grading :
A- Mild : displacement is less than 13 of the width of femoral neck
B- Moderate : Displacement is between 13 and 12
C- Severe : displacement is greater than 12 of the femoral neck width.