SUFE - slipped upper femoral epiphysis

Question 1

pathogenesis

Answer 1

femoral head epiphysis slips inferiorly in relation to femoral neck acute / chronic / acute-on-chronic

Question 2

who gets it?

Answer 2

overweightpre-pubertaladolescentboys (girls less common)hypothyroidism / renal disease may predispose to SUFE

Question 3

how does it present?

Answer 3

paino can have pain in the groino major pitfall: patients can present purely with pain in the knee - obturator nerve supplying hip & knee - clinician may miss it – if child comes with knee, examine hip! limploss of internal rotation of the hip -

Question 4

how is it investigated?

Answer 4

X-ray - changes can be subtle lateral view to detect mild degrees of slip

Question 5

how is it managed?

Answer 5

urgent surgery o pin femoral heado prevent further slippagegreater degree of slip – worse prognosis mild slip – favourable prognosissevere acute slip – gentle manipulation may be attempted, but risks AVNchronic severe slip – may require an osteotomy