Slipped upper femoral epiphysis
(SUFE)

Definition

Epidemilology

Risk factors

Paediatric disorder of slippage
of the proximal epiphysis
of the femur causing hip pain

Onset 10-15y

1/4 bilateral

M>F

FH

Obesity

African-American

Renal osteodystrophy

Male

Endocrine disorder
(hypothyroidism, hypogonadism)

Pathophysiology

Defect
Unclear aetiology (genetics and biomechanics)
Usually after minor injury
Adolescent growth spurt in obese children

Mechanism
Proximal femoral epiphysis becomes displaced through the growth plate (hypertrophic zone)
Femoral head displaced posteroinferiorly in the acetabulum,
femoral neck forwards with external rotation
Prompt tx to prevent avascular necrosis

Clinical
presentation

Pain

Antalgic gait

Diagnosis

Examination

Investigations

History

Character

Radiation
Thigh, knee

Onset
Acute/insidious

Associated symptoms
Antalgic gait

Site
Groin, thigh, knee

Timing
Continous

Bloods
FBC, U+E, LFTs, TFTs (hypothyroidism), bone profile,
Hormone levels (?endocrine cause)

Imaging
X-ray hip (AP, lateral, frog leg): see slipped epiphysis
image

Management

Initial (ABCDE)

Definitive

Surgical

Complications

Avascular necrosis
of femoral head

Malunion and
early arthritis

Types (Loder)
Stable: can weight bear (+/- crutches); common (90%)
Unstable: unable to weight bear; uncommon (10%)

DH
Meds, allergies

FH
Metabolic bone disease,
SUFE

PMH
Growth and development
Known medical conditions (metabolic disease)

SH
Living arrangements, school,
diet, exercise, smoking, alcohol

PC/HPC
Hip/knee/leg pain in overweight
teenage boy, associated limp

Musculoskeletal exam
Hip: antalgic gait, thigh atrophy, externally rotated leg.
reduced ROM (int rotation, flexion, abduction)
Spine: nil
Knee: nil

Abdo pain
Check for referred pain

Genital exam
Check for referred pain

Bedside
Obs (nil)
Measurements (obese BMI)

Joint aspirate
MCS (r/o septic arthritis)

Conservative
Information, advice, support
Referral to orthopedics

Internal fixation
Indication: all patients
MOA: pins fixation; also do
prophylaxis for other side

Medical

Analgesia
Indication: pain
E.g. paracetamol, NSAIDs