What happens to the capital femoral epiphysis in adolescents with a weakened physis?

• A. It will slip anteriorly and superiorly
• B. It fuses prematurely
• C. It can slip posteriorly and inferiorly, separating from the femoral neck
• D. It remains stable with minimal symptoms

Answer: (C)

Adolescents with a weakened growth plate are prone to a slip at the head of the femur. In slipped capital femoral epiphysis, the capital femoral epiphysis moves posteroinferiorly—that is, downward and toward the back—relative to the femoral neck, and can separate from the neck. This posterior-inferior displacement is the hallmark of the condition and explains the typical presentation of hip or knee pain with limited internal rotation and a limp. Premature fusion would stop growth rather than cause a slip, and a stable limb with minimal symptoms doesn’t fit the clinical picture of SCFE. An anterior or superior slip would not occur in this condition.