AKT · Child health/Growth, GI & MSK

Slipped upper femoral epiphysis (SUFE)

Displacement through the proximal femoral physis

Overview

Postero-inferior slip of the femoral head epiphysis through the growth plate, classically in OVERWEIGHT ADOLESCENT boys (10–15y). The leg lies externally rotated; obligatory external rotation on hip flexion is characteristic.

Recognise

Overweight adolescent (10–15y), often boys
Hip/groin/KNEE pain and a limp; leg held EXTERNALLY ROTATED and shortened
Loss of internal rotation; hip flexion forces external rotation (Drehmann sign)

Red flags

Acute unstable slip (unable to weight-bear) — urgent; bilateral in ~20%; endocrinopathy if atypical age

Differentials & how to tell them apart

Perthesyounger (4–8y), avascular necrosis, not a physeal slip

Transient synovitisacute, post-viral, younger

Septic arthritisfebrile, systemically unwell

Muscular strainno X-ray slip

Investigations

X-ray AP + FROG-LEG LATERAL (slip best seen on lateral): the epiphysis slips like "ice-cream off a cone"; Trethowan/Klein line. Consider endocrine work-up if young/atypical.

Management

Urgent surgical fixation (in-situ screw pinning)

1Urgent orthopaedic referral; keep non-weight-bearing. Surgical in-situ pinning.Gate: Do not force reduction of an unstable slip → avascular necrosis risk; pin in situ
2Consider prophylactic fixation of the other hip (bilateral in up to 20%); endocrine work-up if atypical.

Surgical fixation (in-situ pinning) — urgent; percutaneous screw

Key points

Classic stem: an overweight adolescent with knee/thigh pain and an externally rotated leg. The slip is best seen on the FROG-LEG LATERAL film.

Monitor & prognosis

Other hip; avascular necrosis; chondrolysis.

Good with prompt in-situ fixation; AVN worsens outcome.

Source: Paediatric orthopaedics