SUFE – Slipped Upper Femoral Epiphysis

Last Updated on by FRCEM Intermediate

Overview

  • Transphyseal displacement of the upper femoral epiphysis from the metaphysis.
  • X-ray Views: Frog lateral (More sensitive) and AP x-rays
  • Acutely may see inferoposterior slip (best seen on LAT view).
  • Trethowan sign: Klein’s line along sup. border of the femoral neck should intersect femoral head
  • Widening and irregularity of the physis


 

 

 

 

 

Clinical

  • Limping (remember DDx)
  • Groin, thigh or knee pain.
  • Symptoms acute or chronic
  • Early teens (10-17), M>F, obesity, chronic renal disease
  • The leg may be held slightly adducted, externally rotated and shortened.
  • On examination, reduced ROM flexon, abduction and especially internal rotation
  • Beware bilateral disease is common

Management

  • Stable slip – no weight bearing refer ortho for possible internal fixation
  • Unstable – admit today for internal fixation

Complications

  • AVN (avascular necrosis) of the femoral head
  • Degenerative hip arthritis
  • deformity
  • limb length discrepancy

Differential diagnosis

  • Legg-Calve-Perthes disease
  • septic arthritis
  • transient synovitis
  • developmental dysplasia

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