Slipped Capital Femoral Epiphysis (SCFE) is the most common adolescent hip disorder. It occurs when the ball at the top of the thigh bone (femoral head) slips off the neck of the bone through the growth plate (physis). A bit like an ice cream sliding off a cone… Dr Ryno du Plessis, a renowned orthopaedic and joint replacement surgeon in the Western Cape, talks about what it is and why it is often misdiagnosed.  SCFE usually happens during growth spurts in children aged 9 to 16 years and is more common in boys and in children with obesity, endocrine disorders, or other risk factors.  Why is this problem often missed? Despite its frequency, SCFE is routinely misdiagnosed or diagnosed late – unfortunately, sometimes months after symptoms start. Studies show that over 50% of SCFE cases are not diagnosed at the first medical visit. Here’s why: Why does delay matter? The longer the slip is left untreated, the more serious the outcome. Every week or month of delay increases the severity of the deformity, often silently. Late diagnosis risks: Children diagnosed early often need just one screw to stabilise the hip. Those who are diagnosed late may face major reconstructive surgery, longer recovery, and reduced hip function for life. Red flags for parents, teachers and coaches If you notice any of the following signs in a child or teen – especially those who are overweight – take it seriously and ask for a hip X-ray: Radiology – diagnostic challenges Dr Jaco Greyling, a radiologist from SCP Radiology, says SCFE diagnoses can be delayed due to several factors, including He says, the recommended imaging is an anterior-posterior pelvic view which shows malalignment and widening of the growth plate and a frog-leg lateral view, the most sensitive for detecting early or subtle slips.’ ‘Key radiological signs,’ says Dr Greyling are: Follow-up recommendations: Dr Greyling suggests repeat imaging within two weeks if symptoms persist, and an early referral to a paediatric orthopaedic surgeon and an MRI for patients with risk factors and ongoing pain. Who’s at risk? Treatment Early SCFE is usually treated with in-situ fixation using one or two screws. The goal is to stabilise the rounded end of a long bone to prevent further slippage. In cases where both hips are at risk (especially in young or overweight patients), pinning of the opposite hip as well is sometimes recommended to prevent it from occurring. Severe or late cases have a high risk of AVN, which is the death of bone tissue caused by a disruption in its blood supply, leading to pain, stiffness, and potential bone collapse or joint destruction over time and permanent disability. The take-home message SCFE is treatable and preventable if recognised early. If a child has an unexplained limp, especially with thigh or knee pain, don’t assume it’s just a strain. Ask the doctor directly: “Could this be SCFE? Should we get hip X-rays done?” One simple question. One X-ray. It could save a child’s hip.