In Slipped Capital Femoral Epiphysis (SCFE), the 'ice cream falling off the cone' describes the relationship between:

• A The acetabulum displacing superiorly relative to the femoral head
• B The femoral metaphysis subluxing laterally leaving the capital epiphysis in the acetabulum
• C The femoral head remaining in the acetabulum while the neck displaces anterolaterally and superiorly ✓
• D The femoral neck rotating into valgus away from the epiphysis

Explanation

In SCFE, the physis (growth plate) is the weak link — Salter Harris Type I physeal injury. The capital femoral epiphysis remains in the acetabulum while the femoral neck and shaft migrate anterolaterally and superiorly (upward displacement of the metaphysis). On AP X-ray, this appears as the head 'slipping' posteriorly and medially relative to the neck, best seen on the frog-leg lateral view. Treatment is urgent in-situ fixation with a single cannulated screw to prevent further slip and avascular necrosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.