SUFE - Slipped Upper Femoral Epiphysis
- Transphyseal displacement of the upper femoral epiphysis from the metaphysis.
- Frog lateral and AP x-rays
- Acutely may see inferoposterior slip (best seen on LAT view).
- Klein’s line along sup. border of the femoral neck should intersect femoral head
- Widening and irregularity of the physis
Classification
- Acute (symptoms <3/52) or chronic
- Stable (can wt bear with or without crutches)
- Unstable are unable to weight bear
- X-ray: Displacement of epiphysis on metaphysis
- Mild - 0 to ⅓ slip or <300 angulation
- Moderate - ⅓ to ½ slip or 300 - 600 angulation
- Severe slip >½ or >600 angulation
Clinical
- Limp (remember DDx)
- Groin, thigh or knee pain.
- Symptoms acute or chronic (see above)
- Early teens, M>F, obesity, chronic renal disease
- Stable much more common
- Beware unstable (NWB)
- Hip flexed +/- ext rotated (comfort)
- Reduced ROM especially internal rotation
- Beware bilateral disease is common
Complications
- AVN (avascular necrosis) of the femoral head
- Degenerative hip arthritis
Management
- Stable slip - no weight bearing refer ortho for possible internal fixation
- Unstable - admit today for internal fixation
