Slipped Upper Femoral Epiphysis (SUFE)

SUFE is also known as Slipped Capital Femoral Epiphysis (SCFE)

A limp in a child may be due to a minor cause, but the serious differentials has to be exclude to arrive at a proper diagnosis.

Differential diagnosis of a limping child includes….



Slipped Upper Femoral Epiphysis (SUFE) is a disease affecting the femoral head where there is displacement of the upper femoral epiphysis from the femoral neck due to mechanical failure of the cartilaginous epiphysis 

Incidence : 3 in 100 000 children
Male : Female ratio is 5 : 1 


Aetiology And Pathophysiology Of SUFE 

The cause of SUFE is unknown.
           ↓
During puberty 
           ↓
Rapid growth spurt
           ↓
Formation of weaker pericondrial rings
           ↓
Formation of a weaker epiphysis
           ↓
Resulting in a slip of the femoral head


Risk Factors Of SUFE
  • Obesity
  • Puberty 
  • Male sex 


Clinical Presentation Of SUFE
  • Seen commonly in adolescence, 11 – 16 years of age 
  • More common in boys 
  • Left hip is commonly affected 
  • Bilateral in 25% of cases
  • Localized pain in the hip or knee
  • Limping gait / Antalgic gait
  • Decrease range of motion of the hip 


Investigations Of SUFE

SUFE is difficult to diagnose
  • Plain X-Ray
    • AP view of hip joint
    • Frog leg view of pelvis
      • The degree of slippage can be determined    
  • Other investigations are performed only in selected cases
    • MRI, CT scans
    • Bone scan



Treatment Of SUFE

Determining whether SUFE is stable or unstable is ultra important, as unstable SUFE has a higher risk developing complications 
  • Stable SUFE – Able to bear weight
  • Unstable SUFE – Unable to beat weight 

Surgical management 
  • Pinning in situ using a single cannulated hip screw 
    • Reduce and stabilize the slippage
       
  • Prophylactic pinning of opposite side as 25% can be bilateral
     
  • Follow up – To monitor the treatment and to assess the hip joint of the opposite side

Medical management
  • Analgesics 
  • Clutches to minimize weight bearing for 6 – 8 weeks 
  • Physiotherapy 
  • Avoid contact sports till femoral epiphysis is full closed 


Complications Of SUFE
  • Avascular necrosis of the femoral head
  • Deformed hip joint
  • Osteoarthritis – Late adulthood
  • Limp


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1 year ago

[…] Slipped upper femoral epiphysis […]