Slipped Upper Femoral Epiphysis

Musculoskeletal Education Program

RCSI Professorial Unit

Cappagh National Orthopaedic Hospital

Slipped Upper Femoral Epiphysis (SUFE)

Disease of adolescenceAffects the epiphyseal plate of the proximal femurResponsible for part of the growth in length of the femurThe newly formed cartilage cells undergo hypertrophy in the area of the plate adjacent to the proximal femoral shaftWeakest point

Slipped Upper Femoral Epiphysis (SUFE)

During the rapid growth of adolescence, the strength of this part of the epiphyseal growth plate may be reduced to such a level that it is unable to resist normal stressesThe head of the femur and shaft lose their normal relationshipThe capital epiphysis is well supported by the acetabulum, but the femur tends to externally rotate and move proximally

Slipped Upper Femoral Epiphysis (SUFE)

AetiologyOccurs in 11-14 yrs, M>>FOverweightExcess stresses on the hipOften a history of a traumatic episodeCondition is often bilateralSlipping of the second side when the patient is resting in bed during treatment of the first

Slipped Upper Femoral Epiphysis (SUFE)

DiagnosisOften a complaint of pain which may be felt in the groin or referred to the kneeUsually a marked limpMay not be possible to bear weightNo systemic disturbanceO/E affected hip is usually held in external rotation, with restriction of internal rotation and abductionDiagnosis confirmed by x-rayShows disturbance in relationship between the capital epiphysis and femoral neck and shaft

Slipped Upper Femoral Epiphysis (SUFE)

Slipped Upper Femoral Epiphysis (SUFE)

If untreated, a minor displacement may progress and become severeThe slipped epiphysis can unite with the neck of the femur, leading to persistent displacementPermanent shortening of the limbLoss of internal rotationLoss of abduction risk of secondary OA (third and fourth decades of life)

Slipped Upper Femoral Epiphysis (SUFE)

TreatmentComplicated by the risks of causing avascular necrosis of the head of the femurBy disturbing its delicate blood supplyIf slip < 30%, displacement may be acceptedEpiphysis fixed internally with screws and pinsIf slip > 30%, and recent, a gentle manipulative reduction may be triedIf successfully reduced to less than 30%, it is reasonable to proceed to internal fixation, accepting this level of residual displacement

Slipped Upper Femoral Epiphysis (SUFE)

Slipped Upper Femoral Epiphysis (SUFE)

If closed reduction is unsucessful, open reduction and internal fixation may be attemptedBearing in mind the risk of avascular necrosisAfter pinning, it is not long before the epiphysis unites with the diaphysisAs the condition occurs in adolescence, and most longitudinal bone growth occurs at the distal end of the femur, little residual shortening of the limb occurs

Slipped Upper Femoral Epiphysis (SUFE)

When the diagnosis is made lateThe epiphysis has closed with severe deformityLimitation in movement of limb and risk of 2 OAPrognosis may be improved by corrective osteotomyPerformed at subtrochanteric regionRemoval of wedge of bone to correct deformityIf avascular necrosis supervenesArthrodesis - risk of OA in ipsilateral knee, spineTotal hip replacement ? long term survivability of THR