The aim of this study was to examine the epidemiology and outcomes of slipped capital femoral epiphysis (SCFE) in Australian Indigenous populations, and risk factors of contralateral slip.This multicentre, retrospective study included 85 Australian Indigenous patients with SCFE from two Northern Territory hospitals between February 2010 and February 2024. Data such as age, posterior slope angle, and slip characteristics were collected. Risk factors for contralateral slip were identified via penalized logistic regression, and the number needed to treat (NNT) was calculated for prophylactic fixation.The median age at diagnosis was 12. 1 years (IQR 11.2 to 13.0), with a high incidence of valgus slips (10.6%). In total, 73 patients (85.9%) did not have prophylactic contralateral hip pinning, of which 13 patients (17.80%) developed a contralateral slip, with younger age and elevated posterior slope angle as significant risk factors. Patients aged under 12 years with a posterior slope angle greater than 9° had a NNT of two for prophylactic fixation, suggesting targeted benefit. Prophylactic fixation showed no subsequent slip or fixation-related complications in our patient population.SCFE in Australian Indigenous patients presents unique challenges, with a higher proportion of valgus slips than reported in other populations. Prophylactic fixation may be beneficial in younger, high-risk patients. These findings highlight the importance of individualized care and a multidisciplinary approach, particularly in remote communities where healthcare access is limited. Tailored interventions for at-risk individuals may improve outcomes and address healthcare disparities in this vulnerable cohort.