Please enable JavaScript.
Coggle requires JavaScript to display documents.
Slipped upper femoral epiphysis (SUFE) (Risk factors (FH, Obesity,…
Slipped upper femoral epiphysis
(SUFE)
Definition
Paediatric disorder of slippage
of the proximal epiphysis
of the femur causing hip pain
Epidemilology
Onset 10-15y
1/4 bilateral
M>F
Risk factors
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
Types (Loder)
Stable: can weight bear (+/- crutches); common (90%)
Unstable: unable to weight bear; uncommon (10%)
Clinical
presentation
Pain
Character
Radiation
Thigh, knee
Onset
Acute/insidious
Associated symptoms
Antalgic gait
Site
Groin, thigh, knee
Timing
Continous
Antalgic gait
Diagnosis
Examination
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
Investigations
Bloods
FBC, U+E, LFTs, TFTs (hypothyroidism), bone profile,
Hormone levels (?endocrine cause)
Imaging
X-ray hip (AP, lateral, frog leg): see slipped epiphysis
Bedside
Obs (nil)
Measurements (obese BMI)
Joint aspirate
MCS (r/o septic arthritis)
History
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
Management
Initial (ABCDE)
Definitive
Surgical
Internal fixation
Indication: all patients
MOA: pins fixation; also do
prophylaxis for other side
Conservative
Information, advice, support
Referral to orthopedics
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs
Complications
Avascular necrosis
of femoral head
Malunion and
early arthritis
