Early surgical fixation of the epiphysis prevents further slippage and improves functional outcome CLINICAL PEARLS AND PITFALLS Acute (unstable) SCFE is associated with a higher rate of avascular necrosis than chronic (stable) SCFE AP and frog-leg radiographs are the imaging studies of choice for SCFE though ultrasound and MRI are playing an increasing role SCFE typically occurs during the adolescent growth spurt Obesity is a significant risk factor for SCFE Presence of referred pain to the groin, thigh, or knee is common and may result in delayed diagnosis Limited internal hip rotation and pain with external rotation are signs that suggest SCFE Bilateral SCFE occurs in 25% of cases and may not be detectable at the time of initial diagnosis Presence of an endocrinopathy, commonly hypothyroidism, should be suspected in children with SCFE who are outside the normal age range Current Evidence SCFE is the most common hip disorder in adolescent patients and should be familiar to all who care for children in this age group It is twice as common in males than in females, and more common in African-American patients Over 80% of patients with SCFE have body mass index above the 95th percentile, but clinicians must also consider SCFE in patients who are not obese to avoid delayed diagnosis Most children with SCFE are early adolescents in their growth spurt Boys are most commonly affected between 12 and 14 years of age, and girls between 10 and 12 years of age because of their earlier pubertal development SCFE onset after menarche is extremely rare Slippage of capital femoral epiphysis is almost always posterior and inferior relative to the proximal femoral metaphysis, however, displacement anteriorly or superiorly has been reported The epiphysis maintains a normal relationship with the acetabulum Although symptoms are usually unilateral, plain radiographs document bilateral slippage in about 25% of cases, and computed tomographic (CT) scans and MRI in up to 50%