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
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