Current classification systems in slipped capital femoral epiphysis: Clinical relevance, limitations, and future directions.

Abstract

Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder and remains a significant cause of pain, gait disturbance, proximal femoral deformity, and early degenerative hip disease. Accurate classification of SCFE is essential for diagnosis, prognostication, treatment planning, and communication among orthopedic surgeons. Over the past several decades, multiple classification systems have been proposed based on symptom duration, physeal stability, radiographic severity, and deformity morphology. However, substantial variability exists regarding their reliability, prognostic value, and clinical applicability. This review provides a comprehensive overview of the currently available classification systems in SCFE, including temporal, Loder, Southwick, Wilson, epiphyseal tubercle (Maranho), MRI-based, and three-dimensional/statistical shape modeling classifications. Particular emphasis is placed on their historical evolution, clinical relevance, prognostic implications, limitations, and emerging role in modern hip preservation strategies. Among existing systems, the Loder classification remains the most clinically influential because of its strong association with avascular necrosis risk, while the Southwick classification continues to play a central role in quantifying deformity severity and guiding surgical decision-making. Emerging imaging-based and three-dimensional classifications have improved understanding of the rotational and multiplanar nature of SCFE and may facilitate earlier diagnosis, improved deformity characterization, and individualized treatment planning. Nevertheless, no single classification system comprehensively integrates physeal stability, deformity severity, vascular compromise, cartilage injury, and long-term functional prognosis. Current SCFE classification systems remain valuable tools in contemporary clinical practice; however, important limitations persist regarding reproducibility, prognostic accuracy, and integration with modern biomechanical concepts. Future classification frameworks may benefit from a multidomain approach integrating physeal stability, deformity morphology, vascular and biological status, cartilage involvement, and patient-specific prognostic factors, with prospective multicentre validation required before clinical adoption.