Slipped upper femoral epiphysis

Question 1

What is SUFE?

Answer 1

It’s also known as slipped capital femoral epiphysis (SCRE). It’s where the head of the femur is displaced (slips) along the growth plate.

Question 2

Who is SUFE more common in?

Answer 2

It is more common in boys, typically presenting aged 8-15 years, with the average age of 12 in boys. It presents slightly earlier in females with an average age of 11 years and is more common in obese children.

Question 3

What is the typical presentation of SUFE?

Answer 3

• adolescent, obese male undergoing a growth spurt
• may be a history of minor trauma that triggers the onset of symptoms
• suspect SUFE if the pain is disproportionate to the severity of the trauma
• hip, groin, thigh or knee pain
• RROM in the hip
• painful limp
• (presenting symptoms can be vague)

Question 4

What are the examination findings for SUFE?

Answer 4

• patient will prefer to keep the hip in external rotation
• loss of internal rotation of the leg in flexion
• they’ll have limited movement of the hip particularly restricted internal rotation

Question 5

How is SUFE diagnosed?

Answer 5

• x-ray - AP and lateral (typically frog-leg) view x-ray
• blood test usually normal, particularly inflammatory markers to exclude other causes of joint pain
• technetium bone scan
• CT scan
• MRI scan

Question 6

What is the management for SUFE?

Answer 6

Surgery is needed to return the femoral head to the correct position and fix it in place to prevent it slipping further - internal fixation.

Question 7

What are the complications of SUFE?

Answer 7

Complications include OA, avascular necrosis of the femoral head, chondrolysis, and leg length discrepancy.