Slipped upper femoral epiphysis

• What is slipped upper femoral epiphysis (SUFE)?


  Also known as slipped capital femoral epiphysis (SCFE)

  Results from proximal femoral growth plate's weakness -> allows displacement of femoral epiphysis
• What are the RFs of SUFE?


  Male

  Age (typically 9-15 yrs)

  Obesity

  Endocrine disorders (hypothyroidism, hypopituitarism & hypogonadism)

  Ethnicity (esp Afro-Caribbean & Hispanic populations)

  Hx of radiotherapy

  Hx of growth hormone treatment

  Contralateral SUFE
• What are the signs & symptoms of SUFE?


  Hip pain (most commonly left hip, mainly unilateral)

  Limp

  Referred pain to knee

  Reduced ROM, esp on hip flexion

  Positive Trendelenburg gait
• What are the DDx of SUFE?


  Osteoarthritis

  Hip fracture

  Perthes disease

  Hip bursitis

  Septic arthritis
• What are the Inx for SUFE?


  Obs

  Full Hx & examination

  Bloods (FBC, CRP, cultures) -> rule out infective causes

  AP & frog leg XRs (diagnostic)

  
• What is shown in the image?

  Slipped upper femoral epiphysis in L side

  
• What is the management of SUFE?


  Physiotherapy

  Surgery -> fixing displaced epiphysis with a screw

  Prompt treatment to prevent prolonged disruption to blood flow -> can lead to avascular necrosis of femoral head
• What are the possible complications of SUFE?


  Avascular necrosis of femoral head

  SUFE in contralateral hip

  Osteoarthritis -> changes in the shape of femoral head -> increased risk of OA later in life
• In SUFE,

  if child can walk = stable SUFE

  if child is unable to walk = unstable SUFE -> 50% of cases are complicated by osteonecrosis
• Pathophys - SUFE


  Rapid growth spurts/excessive weight -> microfractures in hypertrophic zone of physis -> weakens structural integrity -> progressive stress may lead to complete separation -> slippage -> can compromise blood supply to femoral head -> potential avascular necrosis

  Continued displacement -> alters hip biomechanics -> limping gait & reduced ROM