SUFE

Question 1

What is SUFE?

Answer 1

• Slipped upper femoral epiphysis
• Displacement of the capital femoral epiphysis from the femoral neck through the physeal (growth) plate
• type I Salter-Harris epiphyseal injury at the proximal hip

Question 2

At what age is SUFE most common?

Answer 2

• Esp. adolescents 10-15yo

Question 3

What is SUFE associated with?

Answer 3

• Genetic: blacks > caucasians
• Hormonal effects (which help to thicken the growth plate):
  
  • hypothyroidism
  • Sex hormone secretion, which stabilises growth plate, generally has not begun
• Overweight: mechanical stress
• Trauma: can cause an acute slip

Question 4

What is the classic presentation for SUFE?

Answer 4

• obese adolescent
• non-radiating, dull, aching pain in the groin, thigh or knee
• no history of preceding trauma
• Pain is increased by physical activity
• Pain chronic or intermittent

Question 5

What are the different time courses at which SUFE can present?

Answer 5

• Acute
  
  • the child feels the hip ‘collapse’ and is unable to walk
  • uncommon and needs urgent treatment
• Acute on chronic
  
  • the child has months of discomfort and then worsening over a few weeks with a pronounced limp
• Chronic
  
  • Gradual onset and progression > 3 weeks
  • Most common, 85% pts

Question 6

What are some signs seen with SUFE?

Answer 6

• Look
  
  • Antalgic gait, out-toeing, some shortening of affected limb
  • In chronic setting, may have positive Trendelenburg sign on affected side, due to weakened gluteal muscles

• Feel: tender over joint

• Move
  
  • Limited ROM, especially internal rotation and flexion
  • Whitman’s sign (very reliable): with flexion there is obligate external rotation of the hip
  • Pain at extremes of motion

Question 7

What is the classic sign on XR for SUFE?

Answer 7

• Disruption of Klein’s line (line along lateral border of the femoral neck) on AP view

Question 8

How do we manage SUFE?

Answer 8

Surgery