Slipped Upper Femoral Epiphysis (SUFE)

Condition mainly affecting overweight pre‐pubertal adolescent boys where the femoral head epiphysis slips inferiorly in relation to the femoral neck

Aetiology

  • Age 8-18
  • Pubertal growth
  • Overweight
  • Mainly affects males
  • Racial differences
  • Endocrine/metabolic - hypothyroidism or renal disease may predispose to SUFE

Pathophysiology

  • The growth plate (physis) is not strong enough to support body weight and the femoral epiphysis slips due to the strain
  • A growth spurt may preclude the onset and puberty may be delayed (idiopathic or hypothyroidism)

Clinical presentation

  • Cases can be acute, chronic or acute-on-chronic

Symptoms

  • Hip, groin, thigh or knee pain with limp
    • Patients can present purely with pain in the knee (due to the obturator nerve supplying both the hip and knee joint) - make sure to examine the hip!
  • 1/3 of cases are bilateral

Signs

  • Antalgic gait
  • Loss of internal rotation of the hip

Investigations

  • X-ray - ensure lateral view is obtained to detect mild degrees of slip

Management

  • Urgent surgery to pin the femoral head to prevent further slippage
  • The greater the degree of slip the worse the prognosis and some cases may require hip replacement in adolescence or early adulthood
  • For severe acute slips gentle manipulation may be attempted but this risks avascular necrosis
  • Chronic severe slips may require an osteotomy