What is slipped capital femoral epiphysis (SCFE) treated?

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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Answer

Treatment of slipped capital femoral epiphysis (SCFE) is emergent; therefore, early and accurate diagnosis is paramount. There is no role for observation or attempts at closed reduction.

Classification schemes are as follows:

  • Determine whether the SCFE is acute (< 3 weeks), chronic (3+ weeks), or acute on chronic (3+ weeks of symptoms with acute exacerbation or change).

  • Determine whether the SCFE stable (able to bear weight) or unstable (non-weight bearing). This determination has become more important than acute versus chronic due to the fact that unstable patients have been found to have a high complication rate.

  • Determine the radiographic classification. This is determined by the percentage of displacement of the hip in relation to the neck. Type I is less than 33% displacement, type II is 33-50% displacement, and type III is greater than 50% displacement.

Prophylactic treatment of the asymptomatic hip remains controversial. In Europe, the majority of patients receive prophylactic fixation of the contralateral hip. Each case should be approached individually, and the benefits and risks should be weighed when contemplating surgery on the unaffected hip.

In a review of the literature, prophylactic treatment may be considered in patients younger than 10 years or patients affected by various endocrinopathies because these individuals have higher relative risks for bilateral involvement. Prophylactic treatment should also be considered in a patient or family that is unreliable. In a typical patient who presents with unilateral SCFE, the parents should be warned of possible sequential bilateral involvement. The need for close follow-up and early operative intervention if the other hip becomes symptomatic must be understood by the family.

Delays in diagnosis or treatment can be very detrimental to the patient's outcome. The slip may progress, and increased severity of SCFE leads to early degenerative arthritis. With a diagnostic or treatment delay, stable slips may become unstable, which leads to higher rates of AVN.


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