SUFE - slipped upper femoral epiphysis

Question 1

pathogenesis

Answer 1

femoral head epiphysis slips inferiorly in relation to femoral neck
acute / chronic / acute-on-chronic

Question 2

who gets it?

Answer 2

overweight
pre-pubertal
adolescent
boys  (girls less common)
hypothyroidism / renal disease may predispose to SUFE

Question 3

how does it present?

Answer 3

pain
o can have pain in the groin
o major pitfall: patients can present purely with pain in the knee
- obturator nerve supplying hip & knee
- clinician may miss it – if child comes with knee, examine hip!
limp
loss of internal rotation of the hip -

Question 4

how is it investigated?

Answer 4

X-ray - changes can be subtle

lateral view to detect mild degrees of slip

Question 5

how is it managed?

Answer 5

urgent surgery
o pin femoral head
o prevent further slippage
greater degree of slip – worse prognosis
mild slip – favourable prognosis
severe acute slip – gentle manipulation may be attempted, but risks AVN
chronic severe slip – may require an osteotomy