# Slipped capital femoral epiphysis - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Slipped Capital Femoral Epiphysis - StatPearls (NCBI Bookshelf NBK538302) - https://www.ncbi.nlm.nih.gov/books/NBK538302/ · Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral-epiphysis-full.txt) · Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral-epiphysis-clinical.txt) - Verified date: 2026-08 ## Verified against - Slipped Capital Femoral Epiphysis - StatPearls (NCBI Bookshelf NBK538302) - https://www.ncbi.nlm.nih.gov/books/NBK538302/ - Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral-epiphysis-full.txt) - Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral-epiphysis-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SLIPPED CAPITAL FEMORAL EPIPHYSIS Sources: Slipped Capital Femoral Epiphysis - StatPearls (NCBI Bookshelf NBK538302) - https://www.ncbi.nlm.nih.gov/books/NBK538302/ · Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral-epiphysis-full.txt) · Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital-femoral- epiphysis-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - A young adolescent with hip, thigh, or knee pain that started without injury, especially with a limp, should raise suspicion for this condition [groin pain · hip pain · joint pain · knee pain · limp · thigh pain] - Pain is most often felt in the hip, but can instead be felt in the thigh, knee, or groin - Symptoms typically build for several months before the diagnosis is made, though some patients present within a few weeks - Most patients cannot recall any injury before the pain started, though a history of trauma does not rule the condition out SIGNS - what you find (3) - Turning the hip inward is limited and painful on exam [reduced range of movement] - Bending the hip forward causes it to rotate outward on its own, a finding named for the sign that describes it - Walking can look shuffling, tilted to one side, or guarded, and some patients cannot bear weight at all [refusal to weight-bear] TESTS (7) - Both hips should be X-rayed with front and frog-leg views so the sides can be compared - A line drawn along the top of the femoral neck normally clips the growth plate; when it misses, that is a classic radiographic sign of this condition - Measuring the angle of slip against the shaft of the bone is a more sensitive X-ray method than the intersecting-line test - A break or sharp turn in the smooth cortical outline on the frog-leg view is another radiographic clue, and combining it with the line test improves accuracy - Widening of the growth plate on X-ray can be an early sign before slippage is obvious - MRI can pick up a pre-slip case that plain X-rays miss, showing marrow swelling and a widened growth plate - Bloodwork for thyroid and kidney function is warranted in younger, short, or underweight children to look for an underlying hormonal cause IF NOT THIS - what else fits (3) - A febrile or ill-appearing child with hip pain should be evaluated for joint infection or bone infection instead - When the pain started with a sports injury, a pelvic avulsion fracture, muscle strain, or true fracture should be considered instead - Inflammatory mimics on the differential include transient joint inflammation, Perthes disease of the hip, and Osgood-Schlatter disease of the knee Source Slipped capital femoral epiphysis - disease-level clinical article (slipped-capital- femoral-epiphysis-full.txt) Status traced to the source above 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Slipped Capital Femoral Epiphysis - StatPearls (NCBI Bookshelf NBK538302) - https://www.ncbi.nlm.nih.gov/books/NBK538302/ Why Slipped capital femoral epiphysis is treated surgically and is missed because it presents as knee or thigh pain in a heavy adolescent. The primary-care job is to think of it, X-ray both hips, and stop the child walking on it. No drug is offered below because no medicine treats a slipped physis. Caution KNEE PAIN IS A HIP DIAGNOSIS UNTIL THE HIP IS X-RAYED - the pain is reported at the hip most often (52%), but it also comes as groin pain (13.9%), thigh pain (35%) or knee pain (26%). The knee lies because the medial obturator nerve carries the pain there. THINK OF IT IN EVERY LIMPING ADOLESCENT - the article's standing instruction is to keep SCFE in mind for any pre-adolescent, adolescent or young adult complaining of hip, thigh or knee pain that came on without injury - all the more where they limp or cannot take weight on the leg. NO INJURY IS NOT REASSURANCE - most of these patients report no trauma at all before the symptoms began; but a history of injury does NOT rule SCFE out either. AND IT HAS USUALLY BEEN GOING ON FOR MONTHS - on average the symptoms have run 4 to 5 months by the time the diagnosis is made, though some patients present with less than three weeks of them. THE EXAMINATION SIGN THAT SEPARATES IT - internal rotation on the affected side may be limited, and rotating the hip internally may hurt. Flexion, abduction and internal rotation are all reduced. And the Drehmann sign may be there: flex the hip passively to 90 degrees and the leg rotates outwards whether you want it to or not. X-RAY BOTH HIPS, TWO VIEWS - start with radiographs of both hips: an anteroposterior (AP) view and a frog-leg lateral. Take both sides so the two can be compared. One in four are bilateral - the left hip is affected more often, but roughly 25% of cases involve both, on a range from 8 to 50%. A NORMAL FILM DOES NOT CLOSE IT - where the films show nothing consistent with SCFE but the clinical suspicion remains high, the next step the article gives is magnetic resonance imaging (MRI) to look further. STOP THE CHILD WEIGHT-BEARING WHILE THE REFERRAL IS ARRANGED - the patient and the family are instructed to keep strictly off that leg. Whether the child can bear weight is also what predicts the hip's survival: a stable slip carries under a 10% risk of osteonecrosis, while an unstable one - the child unable to bear weight - carries a higher risk, 24 to 47%. THE TREATMENT IS AN OPERATION - management is chiefly operative, for a stable slip and an unstable one alike. OBESITY IS THE MAIN RISK, WHICH IS WHY THIS IS RISING IN EGYPT - obesity is the single biggest risk factor for SCFE. Recent work reports it appearing at younger ages and more often on both sides, which may reflect how much commoner childhood obesity has become. Onset averages 11.2 years in girls and 12.0 years in boys. A SMALL OR YOUNG CHILD WITH A SLIP NEEDS AN ENDOCRINE WORKUP - hypothyroidism is the commonest cause of a non-idiopathic slip. So a SCFE in a child under ten years, or one whose weight sits below the 50th percentile, is an indication to look for an endocrine cause. THE OTHER LIMPING-CHILD DIAGNOSES TO HOLD BESIDE IT - the article's own differential names septic arthritis and osteomyelitis, especially where the patient is febrile or looks unwell, and then transient synovitis, Perthes disease and Osgood-Schlatter disease. Perthes hits a younger child, 4 to 10 years; a slipped epiphysis hits the adolescent. Both limp, both refer pain to the knee, and both are X-rayed the same way. DELAY IS THE COMPLICATION - a SCFE diagnosed late brings more complications, osteonecrosis of the femoral head among them. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)