Slipped Upper [Capital] Femoral Epiphysis

Slipped Upper Femoral [or Capital] Epiphysis - SUFE (or SCFE) - results in displacement of the epiphysis of the femoral head.  SUFE is most common at 10–15 years of age during the adolescent growth spurt. There can be association with children who are overweight, hypothyroid or hypogonadal but this is not always the case.

SUFE / SCFE can occur in children with other conditions such as Juvenile Idiopathic Arthritis (beware the child with JIA and acute limp and hip restriction).

The presentation can be acute (non-weight bearing) or acute on chronic and tends to be asymmetrical but can involve both hips (20%).  Pain and restriction of hip movement will be apparent and the child may or may not be able to weight bear. 

The diagnosis can be confirmed by radiograph. Requests should ask for a 'frog-leg view' to detect relatively minor 'slips'.  Prompt referral to orthopaedics is needed as treatment is surgical. Delayed treatment increases the likelihood of avascular necrosis, secondary osteoarthritis and disability.

The radiograph below shows a minor degree of 'slip' in the right hip. This is more obvious in the second radiograph below, with the legs in a 'frog-leg' position.

Photograph below shows late presentation of SUFE at the right hip