Slipped Upper Femoral Epiphysis

Musculoskeletal Education Program

RCSI Professorial Unit
Cappagh National Orthopaedic Hospital

Slipped Upper Femoral Epiphysis (SUFE)

Disease of adolescence

Affects the epiphyseal plate of the proximal femur

Responsible

for part of the growth in length of the

femur

The newly formed cartilage cells undergo

hypertrophy in the area of the plate adjacent to the
proximal femoral shaft
Weakest

point

Slipped Upper Femoral Epiphysis (SUFE)

During the rapid growth of adolescence, the strength

of this part of the epiphyseal growth plate may be
reduced to such a level that it is unable to resist
normal stresses

The head of the femur and shaft lose their normal

relationship

The capital epiphysis is well supported by the

acetabulum, but the femur tends to externally rotate
and move proximally

Slipped Upper Femoral Epiphysis (SUFE)

Aetiology
Occurs

in 11-14 yrs, M>>F

Overweight

Excess stresses on the hip

Often a history of a traumatic episode

Condition is often bilateral

Slipping

of the second side when the patient is resting

in bed during treatment of the first

Slipped Upper Femoral Epiphysis (SUFE)

Diagnosis
Often

a complaint of pain which may be felt in the

groin or referred to the knee
Usually a marked limp

No

May not be possible to bear weight

systemic disturbance

O/E

affected hip is usually held in external rotation,

with restriction of internal rotation and abduction

Diagnosis

confirmed by x-ray

Shows disturbance in relationship between the capital

epiphysis and femoral neck and shaft

Slipped Upper Femoral Epiphysis (SUFE)

Slipped Upper Femoral Epiphysis (SUFE)

If untreated, a minor displacement may progress and

become severe

The slipped epiphysis can unite with the neck of the

femur, leading to persistent displacement

Permanent shortening of the limb

Loss of internal rotation
Loss of abduction
risk of secondary OA (third and fourth decades of life)

Slipped Upper Femoral Epiphysis (SUFE)

Treatment
Complicated

by the risks of causing avascular necrosis of

the head of the femur

If

By disturbing its delicate blood supply

slip < 30%, displacement may be accepted

Epiphysis fixed internally with screws and pins

If

slip > 30%, and recent, a gentle manipulative reduction

may be tried

If successfully reduced to less than 30%, it is reasonable to proceed

to internal fixation, accepting this level of residual displacement

Slipped Upper Femoral Epiphysis (SUFE)

Slipped Upper Femoral Epiphysis (SUFE)

If closed reduction is unsucessful, open reduction and

internal fixation may be attempted

Bearing in mind the risk of avascular necrosis

After pinning, it is not long before the epiphysis unites

with the diaphysis

As the condition occurs in adolescence, and most

longitudinal bone growth occurs at the distal end of the
femur, little residual shortening of the limb occurs

Slipped Upper Femoral Epiphysis (SUFE)

When the diagnosis is made late

The

epiphysis has closed with severe deformity

Limitation in movement of limb and risk of 2 OA

Prognosis may be improved by corrective

osteotomy
Performed

at subtrochanteric region
Removal of wedge of bone to correct deformity

If avascular necrosis supervenes

Arthrodesis

- risk of OA in ipsilateral knee, spine

Total hip replacement ? long term survivability of THR