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10 9 8 7 6 5 4 3 2 1 0. Slipped Capital Femoral Epiphysis (SCFE) is an important hip disorder in the adolescent age group involving progressive displacement of the femoral head in relation to the femoral neck, through the open growth plate, posteriorly and inferiorly. However, the epiphysis actually remain seated in the acetabulum, it is the neck which displaces usually anteriorly and superiorly. When the femoral neck and the metaphysis moves antero-superiorly is the typical varus slip which is by far the commonest form of SCFE. The so-called ‘valgus slip’ is rare. Slipped capital femoral epiphysis is associated with unique pathophysiological processes involving the growth plate (the physis). The capital femoral epiphysis is somewhat unique. It is one of the few epiphyses in the body that is inside the joint capsule. The displacement takes place through the layer of hypertrophied mature cartilage cells adjacent to the calcified cartilage zone and the interval produced by separation becomes filled with fibrous tissue, embryonic cartilage and callus particularly at the posterior and inferior angle. Abduction and internal rotation of the hip will be greatly limited by 2 factors: Large hump formed by the fibrous cartilage overgrowth about the anterior exposed portion of the neck impinges against the anterior and superior of the acetabulum. The other factor is that the capital epiphysis is fixed posterior and inferior where further outward movement is limited by its impingement against capsule. SLIPPED CAPITAL FEMORAL EPIPHYSIS is most common in adolescent period with rapid growth plat and in patients with very early on set inferior than 10 years or superior than 16 should be evaluated for endocrine disorder. The incidence of known cases varies from 1 to 10 per 100,000. It is more common in boys with the peak disease onset occurring at 10, 16 years for boys and at 12, 14 years for girls. It is rarely reported after the age of 20 years. SCFE is bilateral in about 20%; 50% of these cases present with both hips involved initially while the other 50% develop SCFE in the contralateral side at a later time. The majority of sequential bilateral slips develop within 18 months of the first side presentation. Like DDH, SCFE affects the left side more than the right. The cause of this is unknown. One theory proposed suggests a role for a certain sitting posture of right handed children which is more common than in left handed children. Younger patients with open triradiate cartilages and those with endocrine or metabolic abnormalities are at much higher risk for bilateral involvement. Obesity is a risk factor because it places more shear forces around the proximal growth plate in the hip. The increase of androgens, growth hormone deficiency and endocrine disorder are considerate risk factors. Also trauma is often implicated, tipping the delicate balance which results in the slippage. Anatomical, histological, and mechanical factors have roles in the disease process. ‘Slippage’ occurs when the shear forces imparted exceed the strength of the growth plate. In patients with SCFE, the growth plate is unusually widened, primarily due to expansion of the zone of hypertrophy. This is usually apparent on plain X-ray (often called a ‘pre-slip’ for cases where no displacement has yet occurred). The hypertrophic zone typically constitutes 15–30% of the normal width of the growth plate. In SCFE, this can increase by up to 80% of the width of the growth plate. Histologically, abnormal cartilage maturation, endochondral ossification, and perichondral ring instability occur. This leads to less organization of the normal cartilaginous columnar architecture which weakens the growth plate and slippage occurs through this weakened area. The shear forces imparted to the physis are proportional to body weight. Children with obesity are predisposed. SCFE is typically seen during the adolescent growth spurt . Moreover, anatomical changes such as retroversion of greater than 10° and an abnormal inclination of the proximal femoral growth plate, serve to increase the net effect of shear forces across the growth plate, predisposing to slippage.