Slipped Capital Femoral Epiphysis (SCFE)

1. Clinical Overview

Summary

Slipped Capital Femoral Epiphysis (SCFE), also known as Slipped Upper Femoral Epiphysis (SUFE) or Epiphyseolysis Capitis Femoris, is the most common hip disorder in adolescents and represents a true orthopaedic emergency. [1,2] SCFE is characterized by posteroinferior displacement of the proximal femoral epiphysis (femoral head) relative to the metaphysis (femoral neck) through the physis (growth plate). The condition affects approximately 10 per 100,000 adolescents, with a male:female ratio of 2-3:1. [3,4]

The pathophysiology involves mechanical overload of a weakened physis during the adolescent growth spurt, strongly associated with obesity (> 80% of patients), endocrine disorders (hypothyroidism, growth hormone deficiency), and genetic predisposition. [5,6] The condition typically presents in boys aged 12-16 years and girls aged 10-14 years, coinciding with the peak adolescent growth spurt when the physis is relatively weakened. [4]

SCFE presents with hip, groin, thigh, or knee pain (referred pain in up to 50% of cases), limp, and the pathognomonic sign of obligate external rotation on hip flexion (Drehmann sign). [1,2] Diagnosis is confirmed by plain radiographs (AP pelvis and frog-leg lateral) demonstrating the slip, with key radiographic signs including Klein's line abnormality and Trethowan sign. [7]

The Loder classification based on physeal stability is the most clinically important classification system: [8]

• Stable SCFE (90%): Able to weight-bear with or without crutches; AVN risk less than 5%
• Unstable SCFE (10%): Unable to weight-bear; AVN risk 20-50%

Treatment is urgent surgical stabilization with in situ pinning (single cannulated screw fixation) to prevent slip progression and reduce the risk of devastating complications, particularly avascular necrosis (AVN) and chondrolysis. [9,10] Bilateral involvement occurs in 20-40% of cases, necessitating examination and imaging of both hips. [11] The controversy regarding prophylactic pinning of the contralateral hip remains unresolved, with current practice varying by institution. [12]

Prognosis is excellent for stable SCFE treated with in situ pinning (low AVN risk, good functional outcomes), but unstable SCFE carries a high risk of AVN despite optimal treatment, leading to long-term morbidity including femoroacetabular impingement (FAI) and premature osteoarthritis. [8,13]

Clinical Pearls

"Obese Adolescent Boy with Knee Pain = Always Examine the Hip": SCFE is the most common cause of adolescent hip pain. Referred knee pain occurs in 15-50% of cases and is frequently the ONLY presenting complaint. Missing this diagnosis risks catastrophic AVN.

"Obligate External Rotation on Hip Flexion is Pathognomonic": Drehmann sign. As the affected hip is passively flexed, it automatically rotates externally due to the posteroinferior position of the femoral head.

"Frog-Leg Lateral X-Ray is ESSENTIAL": AP radiograph alone may miss subtle slips in up to 30% of cases. Always obtain BOTH views of BOTH hips.

"Unstable = Unable to Weight-Bear = Urgent Surgery": Loder classification is the single most important prognostic factor. Unstable SCFE has 20-50% AVN risk even with optimal treatment.

"Klein's Line Doesn't Intersect = SCFE": On AP radiograph, a line drawn along the superior femoral neck should intersect the lateral portion of the femoral epiphysis. In SCFE, it does not (Trethowan sign).

"Bilateral in 20-40% – Always Image and Monitor Contralateral Hip": Sequential bilateral involvement is common, usually within 18 months of the first slip.

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2. Epidemiology

Demographics

Geographic Variation

Risk Factors

Exam Detail: Emerging Evidence on Leptin: Recent systematic reviews suggest that elevated leptin levels may independently contribute to SCFE development, regardless of obesity status, potentially through direct effects on physeal cartilage biology. [3] This may explain SCFE in non-obese individuals.

Vitamin D Hypothesis: Geographic regions with colder temperatures and lower UV indexes have higher SCFE rates, while regions with higher temperatures and higher UV indexes have lower rates, suggesting vitamin D deficiency may play a role. [4]

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3. Aetiology and Pathophysiology

Anatomy

Normal Anatomy

• Proximal Femoral Physis: Growth plate between the epiphysis (femoral head) and metaphysis (femoral neck)
• Blood Supply: Predominantly from medial and lateral femoral circumflex arteries via retinacular vessels traversing the posterior femoral neck
• Physis Orientation: Normally inclined ~30° from horizontal (more vertical in younger children)
• Physeal Closure: Girls 14-16 years; Boys 16-18 years

SCFE Deformity

In SCFE, the epiphysis (femoral head) remains in the acetabulum (constrained by the ligamentum teres and capsule), while the metaphysis (femoral neck) displaces anterosuperiorly relative to the epiphysis. Radiographically, this appears as posteroinferior displacement of the epiphysis.

Pathophysiological Mechanisms

1. Physeal Weakness During Growth Spurt

The physis is vulnerable during the adolescent growth spurt due to:

• Widening of the physeal cartilage (proliferative zone hypertrophy)
• Hormonal factors: Oestrogen strengthens the physis and promotes closure; testosterone and growth hormone may temporarily weaken it
• Biomechanical factors: Increased physeal height reduces shear strength
• Relative vascularity changes during rapid growth

2. Mechanical Overload

Shear forces across the physis are increased by:

• Obesity: Increased mechanical load (gravitational and inertial forces)
• Femoral retroversion: Abnormal hip mechanics
• Acetabular morphology: Deeper, more vertical acetabulum increases shear
• Physis orientation: More vertical physis = higher shear stress

3. Slip Progression

The slip typically progresses gradually (chronic) over weeks to months, but acute-on-chronic exacerbation or purely acute slips can occur with trauma or sudden force.

Biomechanical Classification of Slip

Blood Supply and AVN Pathogenesis

AVN occurs through:

1. Mechanical disruption of retinacular vessels (unstable slip, displaced epiphysis)
2. Intracapsular tamponade (haemarthrosis in unstable SCFE increases intracapsular pressure, compressing retinacular vessels)
3. Iatrogenic injury during reduction or fixation

Exam Detail: Loder's Landmark Study (1993): Demonstrated that the ability to weight-bear is the single most important prognostic factor. [8] Unstable SCFE (unable to weight-bear) has dramatically higher AVN risk (20-50%) compared to stable SCFE (less than 5%), irrespective of slip severity or duration.

Why? Unstable SCFE indicates complete physeal disruption with loss of periosteal continuity, leading to:

• Haemarthrosis and intracapsular tamponade
• Disruption of retinacular vessels
• Higher risk of further displacement

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4. Classification Systems

Loder Classification (Stability) – MOST IMPORTANT

Clinical Application: This is the single most important classification for treatment planning and prognostication. [8]

Temporal Classification (Fahey/Wilson)

Note: Temporal classification is less reliable for predicting AVN than Loder classification and is no longer routinely used for treatment decisions. [8]

Severity Classification (Southwick Angle)

Southwick angle = Angle between epiphyseal line and femoral shaft on frog-leg lateral radiograph

Clinical Significance:

• Severity correlates with long-term risk of femoroacetabular impingement (FAI) and osteoarthritis
• Severe slips (> 50°) may require corrective osteotomy for residual deformity [13]
• In situ pinning for slips > 35° may be associated with worse long-term functional outcomes due to persistent FAI [15]

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5. Clinical Presentation

Symptoms

Examination Findings

Clinical Pearl: The "Knee Pain Trap": Up to 50% of children with SCFE present with isolated knee pain without hip symptoms. This is a well-recognized diagnostic pitfall. [1,2]

Golden Rule: Any adolescent with knee pain and no obvious knee pathology MUST have a full hip examination and radiographs of BOTH hips.

Examination Technique

Inspection

• Observe gait (antalgic, Trendelenburg)
• Resting leg position (external rotation)
• Leg length discrepancy
• Thigh/gluteal muscle wasting (chronic cases)

Palpation

• Hip joint tenderness (anterior)
• Greater trochanter position (may be prominent)

Range of Motion Testing

1. Flexion: Supine; flex hip to 90°
2. Drehmann Sign: Pathognomonic
   • Passively flex hip from neutral
   • Observe for obligate external rotation
3. Internal Rotation: Most sensitive
   • Test in extension (supine, hip neutral)
   • Test in 90° flexion (more sensitive)
   • Reduced or absent internal rotation is the hallmark
4. Abduction/Adduction
5. Log roll test: Gentle internal/external rotation of extended leg; pain suggests intra-articular pathology

Neurovascular Examination

• Distal pulses, sensation, motor function (rule out complications)

Differential Diagnosis

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6. Investigations

Imaging – CRITICAL FOR DIAGNOSIS

Plain Radiographs – FIRST-LINE

ESSENTIAL VIEWS:

1. AP Pelvis (both hips)
2. Frog-Leg Lateral (both hips) OR Cross-Table Lateral

Why Both Views? AP radiograph alone may miss up to 30% of slips, especially subtle or early cases. [7]

Why Both Hips? Bilateral involvement in 20-40%; contralateral hip must be assessed. [11]

AP Pelvis Findings

Frog-Leg Lateral Findings – MOST SENSITIVE

Clinical Pearl: Klein's Line Technique:

1. On AP radiograph, draw a line along the superior border of the femoral neck
2. This line should intersect the lateral 20% of the femoral epiphysis on the normal side
3. In SCFE, the line does not intersect the epiphysis (passes above or lateral to it)

Limitation: Klein's line may be normal in subtle slips (sensitivity ~60-70% for mild slips). Always obtain frog-leg lateral. [7]

Advanced Imaging

Laboratory Investigations

Not routinely required for diagnosis, but indicated if:

Atypical Features

• Age less than 10 years
• Bilateral presentation
• Non-obese patient
• No clear mechanical risk factors

Screen for Endocrinopathy

Exam Detail: Endocrine Association: While most SCFE is "idiopathic" (obesity-related), endocrinopathy is present in 5-10% and should be actively sought in atypical presentations. [1,2]

Key Clues:

• Age less than 10 years (before typical growth spurt)
• Short stature or delayed puberty
• Bilateral SCFE
• Severe slip without obesity

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7. Management

Initial Management – SCFE IS AN ORTHOPAEDIC EMERGENCY

Immediate Actions (Emergency Department / Primary Care)

1. Stop Weight-Bearing Immediately

   • Strict non-weight-bearing (wheelchair/stretcher)
   • Rationale: Further displacement can convert stable → unstable, increasing AVN risk

2. Analgesia

   • Paracetamol ± NSAID
   • Opioids if severe pain

3. Urgent Orthopaedic Referral

   • Same-day for suspected SCFE
   • Unstable SCFE = immediate referral for emergency surgery (within 24 hours) [8]

4. Imaging

   • AP pelvis + Frog-leg lateral radiographs of BOTH hips

5. Assess Stability (Loder Classification)

   • Can the patient weight-bear?
   • This determines urgency and prognosis

Surgical Management – DEFINITIVE TREATMENT

Indications for Surgery

ALL patients with SCFE require surgical stabilization, regardless of severity or stability. [9,10]

Goals:

• Prevent further slip progression
• Stabilize the physis
• Minimize risk of AVN
• Preserve hip function

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Stable SCFE (90% of cases)

Treatment: In Situ Pinning with Single Cannulated Screw

Technique: [9,10]

• Percutaneous, fluoroscopy-guided
• Single 6.5-7.3mm partially-threaded cannulated screw
• Screw placed in center-center position (AP and lateral views)
• Screw penetrates physis and engages epiphysis
• No attempt at reduction (reduces AVN risk)
• Screw threads do NOT cross physis (allows physeal closure)

Timing:

• Urgent (within 24-48 hours of diagnosis)
• Delay increases risk of slip progression

Post-operative Management:

• Protected weight-bearing initially (toe-touch or partial)
• Progress to full weight-bearing as tolerated (usually 4-6 weeks)
• Physiotherapy (ROM, strengthening)
• Follow-up until physeal closure (radiographs every 3-6 months)
• Monitor for:
  • Screw penetration
  • AVN (rare in stable SCFE)
  • Slip progression (rare after fixation)
  • Contralateral slip

Outcomes:

• Excellent in most cases
• AVN risk less than 5% [8]
• Most patients return to normal activities
• Long-term risk of FAI and OA, especially if Southwick angle > 35° [15]

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Unstable SCFE (10% of cases) – ORTHOPAEDIC EMERGENCY

Treatment: Urgent Surgical Stabilization

Key Principles: [8,10]

1. Urgent surgery (within 24 hours)
2. Gentle handling; avoid forced reduction
3. Capsulotomy may decompress intracapsular haemarthrosis
4. In situ pinning vs. gentle reduction (controversial)

Surgical Options:

Current Consensus: [10,17]

• Gentle reduction (if any) is acceptable
• Forced/aggressive reduction is contraindicated (high AVN risk)
• Many surgeons perform in situ pinning without reduction to minimize AVN risk
• Modified Dunn procedure in experienced centers offers anatomical reduction with acceptable AVN risk (~10%), especially for severe unstable slips [17]

Post-operative Management:

• Non-weight-bearing initially (6-8 weeks or until pain-free)
• Close monitoring for AVN (clinical + radiographic)
• If AVN develops: salvage options include core decompression, osteotomy, or arthroplasty

Outcomes:

• AVN risk 20-50% despite optimal treatment [8]
• Long-term morbidity high
• Many require further surgery (osteotomy, arthroplasty)

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Severe SCFE (Southwick Angle > 50°)

Controversial Management:

Current Practice:

• Most surgeons perform in situ pinning for severe stable SCFE
• Corrective osteotomy considered if:
  • Southwick angle > 50-60°
  • Severe symptoms/FAI
  • Performed in specialist centers

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Contralateral Hip – PROPHYLACTIC PINNING CONTROVERSY

Key Facts: [11,12]

• 20-40% of SCFE patients develop bilateral involvement
• 50-60% present with simultaneous bilateral slips
• 40-50% develop sequential bilateral SCFE (contralateral slip within 18 months)

Prophylactic Pinning: Indications:

Against Prophylactic Pinning:

• Risk of complications in 5-10% (screw penetration, fracture, altered growth)
• Requires second surgery for hardware removal (~30% of cases)
• Most contralateral hips do NOT slip (60-80%)
• Close surveillance with serial radiographs is an acceptable alternative [12]

Current Practice:

• No consensus
• Practice varies by institution and surgeon preference
• Shared decision-making with patient/family recommended
• Close surveillance until physeal closure is mandatory if prophylactic pinning not performed

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8. Complications

Early Complications

Late Complications

Exam Detail: AVN Classification (Kalamchi-MacEwen):

• Type I: Focal, less than 1/3 of femoral head
• Type II: More extensive, > 1/3
• Type III: Total femoral head necrosis

Chondrolysis: Devastating complication; rapid joint space narrowing (less than 3mm) within 3-6 months of surgery. Exact mechanism unclear; risk factors include pin penetration, infection, and prolonged immobilization. Often leads to stiffness and early OA.

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9. Prognosis and Outcomes

Short-Term Outcomes (1-2 years)

Long-Term Outcomes (10-40 years)

Functional Outcomes (Long-Term Studies)

• In situ pinning for slips less than 35°: Excellent outcomes in 80-90% [15]
• In situ pinning for slips > 35°: FAI symptoms in 40-60%; many require further surgery [15]
• Unstable SCFE: 40-60% require further surgery (AVN salvage, corrective osteotomy, arthroplasty)
• OA Development: 20-40% by age 40, especially in moderate-severe slips and unstable SCFE [13]

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10. Prevention

Primary Prevention

• Obesity prevention: Public health initiatives; dietary and exercise counseling
• Vitamin D supplementation: Emerging evidence for role in high-risk populations [4]
• Endocrine screening: In at-risk children (short stature, delayed puberty)

Secondary Prevention

• Early diagnosis: High index of suspicion in obese adolescents with hip/knee pain
• Prompt surgical stabilization: Prevents slip progression and AVN
• Contralateral hip surveillance: Serial radiographs every 3-6 months until physeal closure [11,12]
• Prophylactic pinning: Consider in high-risk patients (endocrinopathy, age less than 10, radiographic risk factors) [12]

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11. Evidence and Guidelines

Key Guidelines

Landmark Studies

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12. Examination Focus

MRCPCH / Paediatric Viva Scenarios

Scenario 1: Missed Diagnosis

Viva Question: "A 13-year-old obese boy presents to GP with 6 weeks of left knee pain. Knee examination and X-ray are normal. He is diagnosed with 'growing pains' and sent home. Three months later, he is unable to weight-bear. What went wrong?"

Model Answer:

• SCFE commonly presents with referred knee pain (up to 50% of cases) [1,2]
• Golden rule: Any adolescent with knee pain and normal knee examination must have hip examined and hip radiographs performed
• Missed diagnosis led to slip progression, potentially converting stable → unstable SCFE
• Unstable SCFE has AVN risk 20-50% vs less than 5% for stable [8]
• Learning point: Always consider SCFE in obese adolescent with knee pain

Scenario 2: Unstable SCFE

Viva Question: "A 12-year-old girl cannot weight-bear on her right leg after a fall. Hip X-ray shows SCFE. What is the urgency and why?"

Model Answer:

• Unable to weight-bear = Unstable SCFE (Loder classification) [8]
• Orthopaedic emergency: Requires urgent surgery within 24 hours
• AVN risk 20-50% in unstable SCFE due to:
  • Intracapsular haemarthrosis → tamponade → retinacular vessel compression
  • Complete physeal disruption
• Management: Urgent in situ pinning; avoid forced reduction
• Prognosis: Guarded; high complication rate despite optimal treatment

Scenario 3: Contralateral Hip

Viva Question: "You have successfully treated a 14-year-old with left-sided stable SCFE with in situ pinning. What follow-up is required?"

Model Answer:

• Bilateral involvement in 20-40% [11]
• 50-60% present simultaneously; others within 18 months
• Follow-up:
  • Serial radiographs (both hips) every 3-6 months until physeal closure
  • Clinical examination (contralateral hip ROM, pain, limp)
  • "Educate family: Return immediately if new symptoms"
• Prophylactic pinning controversial; consider if:
  • Endocrinopathy present
  • Age less than 10 years
  • High-risk radiographic features [12]

FRCS (Tr&Orth) / Surgical Viva

Viva Question: "Describe your surgical technique for in situ pinning of stable SCFE."

Model Answer: Pre-operative:

• Confirm diagnosis (AP + frog-leg lateral radiographs, both hips)
• Assess stability (Loder classification)
• Consent: Risks (AVN less than 5%, screw complications, leg length discrepancy, further surgery)

Technique:

• Position: Supine on radiolucent table (NOT traction table; avoid inadvertent reduction)
• Approach: Percutaneous, lateral proximal thigh
• Guidewire: Under fluoroscopy (AP + lateral):
  • "Entry point: Anterolateral femoral neck, ~1cm distal to vastus ridge"
  • Aim for center-center position (center of femoral head on AP and lateral)
  • Avoid posterior placement (retinacular vessels)
• Screw: 6.5-7.3mm partially-threaded cannulated screw
  • Penetrates physis, engages epiphysis
  • Threads do NOT cross physis
  • "Tip: 5mm from subchondral bone (avoid joint penetration)"
• Confirm position: AP + lateral fluoroscopy
• Single screw adequate for stable SCFE [9,10]

Post-operative: Protected weight-bearing; physiotherapy; follow-up until physeal closure

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13. Patient and Layperson Explanation

What is SCFE?

SCFE stands for Slipped Capital Femoral Epiphysis. It's a hip condition that affects teenagers, usually during their growth spurt. The "ball" of the hip joint (called the femoral head) slips backward from its normal position on top of the thighbone.

Think of it like a scoop of ice cream sliding off the top of a cone.

Who gets SCFE?

• Teenagers (usually boys aged 12-16, girls aged 10-14)
• More common in children who are overweight or obese
• Sometimes linked to hormone problems (thyroid, growth hormone)

What are the symptoms?

• Pain in the hip, groin, thigh, or knee (yes, knee pain is common even though it's a hip problem!)
• Limping
• Difficulty walking, running, or climbing stairs
• Leg may look "turned outward"

Important: Sometimes the only symptom is knee pain, which can be confusing. That's why doctors always check the hip when a teenager has knee pain.

How is it diagnosed?

X-rays of both hips show the "slip."

How is it treated?

Surgery is needed to stop the hip from slipping further. The surgeon puts a screw through the bone to hold the ball of the hip in place. This is usually done urgently (within a day or two of diagnosis).

What happens after surgery?

• Most teenagers recover well and can return to normal activities
• Crutches are needed for a few weeks
• Physiotherapy helps with strengthening and movement
• Follow-up appointments are important to check the other hip (it can slip too in about 20-40% of cases)

What if SCFE is not treated?

If SCFE is not treated, the hip can slip further, causing:

• Serious damage to the blood supply of the hip (called "avascular necrosis")
• Long-term pain and stiffness
• Arthritis in the hip at a young age

Can SCFE be prevented?

• Maintaining a healthy weight is the best way to reduce the risk
• If your child has hormone problems, regular check-ups are important

Will the other hip be affected?

Yes, it can be. In about 20-40% of cases, SCFE affects both hips (either at the same time or within 18 months). That's why doctors monitor both hips closely.

Key Takeaway for Parents

If your teenager has hip pain, thigh pain, or knee pain and is limping, especially if they are overweight, see a doctor urgently. SCFE needs quick treatment to prevent serious complications.

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14. References

Primary Sources

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2. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666-679. PMID: 17077339. DOI: 10.5435/00124635-200611000-00002.

3. Bouchard MD, Vescio BG, Munir M, et al. The Epidemiology of Slipped Capital Femoral Epiphysis in Children and Adolescents: A Systematic Review of Risk Factors and Incidence Across Populations. JBJS Rev. 2025 May 22;13(5). PMID: 40403127. DOI: 10.2106/JBJS.RVW.25.00052.

4. Miles DT, Wilson AW, Scull MS, Moses W, Quigley RS. A New Look on the Epidemiology of Slipped Capital Femoral Epiphysis: A Topic Revisited. J Pediatr Soc North Am. 2023 Nov;5(4):705. PMID: 40432939. DOI: 10.55275/JPOSNA-2023-705.

5. Loder RT, Skopelja EN. The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthop. 2011 Sep 21;2011:486512. PMID: 24977061. DOI: 10.5402/2011/486512.

6. Perry DC, Metcalfe D, Lane S, Turner S. Childhood Obesity and Slipped Capital Femoral Epiphysis. Pediatrics. 2018 Nov;142(5):e20181067. PMID: 30348751. DOI: 10.1542/peds.2018-1067.

7. Fischer-Colbrie ME, Louer CR, Bomar JD, et al. Predicting epiphyseal stability of slipped capital femoral epiphysis with preoperative CT imaging. J Child Orthop. 2020 Feb 1;14(1):68-75. PMID: 32165983. DOI: 10.1302/1863-2548.14.190123.

8. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: The importance of physeal stability. J Bone Joint Surg Am. 1993;75(8):1134-1140. PMID: 8354671. DOI: 10.2106/00004623-199308000-00003.

9. Chervonski E, Wingo T, Pargas-Colina C, Castaneda P. Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis. J Pediatr Orthop B. 2024 Sep 1;33(5):437-442. PMID: 37811577. DOI: 10.1097/BPB.0000000000001139.

10. Venkatadass K, Prasad VD, Parsana C, Gomathi A, Rajasekaran S. A Simple Modified Technique for In-Situ Screw Fixation in Slipped Capital Femoral Epiphysis. Indian J Orthop. 2021 Aug;55(4):1022-1027. PMID: 34194660. DOI: 10.1007/s43465-021-00382-w.

11. Fedorak GT, Brough AK, Miyamoto RH, Raney EM. The Epidemiology of Slipped Capital Femoral Epiphysis in American Samoa. Hawaii J Med Public Health. 2018 Sep;77(9):215-219. PMID: 30221075.

12. Khalifa A. Fix it or risk it? Revisiting contralateral hip prophylactic fixation in unilateral slipped capital femoral epiphysis: an updated review of the past decade's literature. Eur J Orthop Surg Traumatol. 2025 Mar 2;35(1):84. PMID: 40025359. DOI: 10.1007/s00590-025-04191-x.

13. Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009 Mar;467(3):704-16. DOI: 10.1007/s11999-008-0687-4.

14. Fedorak GT, Brough AK, Miyamoto RH, Raney EM. The Epidemiology of Slipped Capital Femoral Epiphysis in American Samoa. Hawaii J Med Public Health. 2018 Sep;77(9):215-219. PMID: 30221075.

15. Accadbled F, Murgier J, Delannes B, Cahuzac JP, de Gauzy JS. In situ pinning in slipped capital femoral epiphysis: long-term follow-up studies. J Child Orthop. 2017 Apr;11(2):107-109. PMID: 28529657. DOI: 10.1302/1863-2548-11-160282.

16. Upasani VV, Fischer-Colbrie ME, Louer CR, et al. Predicting epiphyseal stability of slipped capital femoral epiphysis with preoperative CT imaging. J Child Orthop. 2020 Feb 1;14(1):68-75. PMID: 32165983. DOI: 10.1302/1863-2548.14.190123.

17. Abdelnasser MK, Hassan AA, Ibrahim M, Ibrahim AH, Abol Oyoun N. Does the development of AVN after the modified Dunn procedure for slipped capital femoral epiphysis (SCFE) depend on slip stability? A systematic review and meta-analysis. BMC Musculoskelet Disord. 2025 Dec 16;26(1):1097. PMID: 41402796. DOI: 10.1186/s12891-025-09095-9.

18. Kitano T, Nakagawa K, Wada M, Moriyama M. Closed reduction of slipped capital femoral epiphysis: high-risk factor for avascular necrosis. J Pediatr Orthop B. 2015 Jul;24(4):281-5. PMID: 25812031. DOI: 10.1097/BPB.0000000000000170.

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Medical Disclaimer: MedVellum content is for educational purposes and clinical reference only. Clinical decisions must account for individual patient circumstances, local guidelines, and specialist input. SCFE is a time-critical orthopaedic emergency requiring urgent specialist assessment and surgical management. Always consult appropriate orthopaedic specialists for definitive diagnosis and treatment planning.