Paediatrics

Slipped Upper Femoral Epiphysis

Slipped upper femoral epiphysis (SUFE/SCFE) is displacement through the proximal femoral growth plate, usually around adolescence; suspected disease requires non-weight-bearing and urgent paediatric orthopaedic stabilisation.

In a nutshell

Slipped upper femoral epiphysis is a proximal femoral physeal slip in an adolescent, often associated with obesity. Groin, thigh or knee pain plus a limp and loss of hip internal rotation should trigger bilateral hip imaging. Keep the child non-weight-bearing and refer urgently; inability to weight-bear defines an unstable, high-avascular-necrosis-risk emergency. Stabilisation is usually in situ for stable slips, with specialist-led management of unstable or severe disease.

Classic presentation

An overweight adolescent has several weeks of knee pain and a limp; the hip is externally rotated with markedly reduced internal rotation, and the knee examination is normal.

Key points

Knee-only pain can be referred from SUFE; examine the hip.
Stable means the child can weight-bear; unstable means they cannot.
Keep suspected SUFE non-weight-bearing and arrange urgent paediatric orthopaedic assessment.
Image both hips; use the local view protocol and do not force an unstable hip into a painful position.
Avoid forceful reduction of a chronic stable slip because of avascular necrosis risk.
Young, thin, short or bilateral cases need specialist assessment for endocrine or metabolic disease.

First-line investigation

Urgent bilateral hip radiographs with documented weight-bearing status and hip examination; MRI is specialist-led if the films are negative but suspicion persists.

Management

Protect the hip

Make the child non-weight-bearing, avoid forceful movement and arrange urgent paediatric orthopaedic assessment.^1,2
Treat inability to weight-bear as an unstable emergency with high avascular-necrosis risk.¹

Image both hips

Arrange bilateral hip radiographs through the paediatric orthopaedic pathway; do not force a painful or unstable hip into a frog-lateral position.^1,2
Use MRI selectively for an occult or early slip when plain radiographs do not answer the clinical question.^2,3

Stabilise and investigate

Stable slips are usually stabilised in situ; unstable or severe slips need specialist emergency fixation decisions without promising a universal technique.^1,2
Consider endocrine or metabolic assessment in young, underweight, short or bilateral presentations, and assess the contralateral hip.^1,2

Watch both hips

Monitor for avascular necrosis, chondrolysis, deformity, impingement and a contralateral slip; use current BNF-based analgesia and specialist rehabilitation.^1,5

Exam traps

The knee can be normal even when the hip has slipped.
Stable versus unstable is based on ability to weight-bear, not simply pain severity or slip angle.
Do not forcefully reduce a chronic stable slip.
An atypically young or thin patient needs endocrine consideration, not reassurance that obesity is absent.

Illustrations

Klein line on the anteroposterior radiographAn AP pelvic radiograph with the line of Klein drawn along the superior femoral neck, showing failure to intersect the slipped epiphysis on the affected side; retain source attribution while image remediation remains separate.Mikir at English Wikipedia, Wikimedia Commons · Public domain

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.