EMed

SUFE - Slipped Upper Femoral Epiphysis

SUFE Frog Leg View
Frog leg view

Background

  • 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
SUFE Klein Lines
Klein lines

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 <30° angulation
    • Moderate - ⅓ to ½ slip or 30° - 60° angulation
    • Severe slip >½ or >60° 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

Content by Dr Íomhar O' Sullivan 23/01/2012. Last reviewed 31/08/22