Slipped Upper Femoral Epiphysis (SCFE or SUFE) is a very common condition in the rapidly growing child. It results in effect a slippage of the femoral head (ball) from the rest of the femur. It is like a fracture through the ball/neck junction, but it behaves very differently.

This is due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.

The condition is diagnosed based on a careful history, physical examination, observation of the gait/walking pattern, and X-rays of the hip. The X-rays help confirm the diagnosis by demonstrating that the upper end of the thigh bone does not line up with the portion called the femoral neck.

 

Symptoms

SUFE’s usually occur during rapid growth in puberty between the ages of 8 till 15. The child usually complains of knee pain or hip pain and can often present with a limp. As it becomes more severe the slip can result in a shortened leg and with a twist outwards.

• Slipped Upper Femoral Epiphysis Slipped Upper Femoral Epiphysis
• Slipped Upper Femoral Epiphysis Slipped Upper Femoral Epiphysis
• Surgical Treatment of SUFE Surgical Treatment of SUFE
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Treatment

A SUFE is a orthopaedic emergency and needs urgent treatment. Dr Balakumar is one the few surgeons in Australia who has been trained in a novel technique that aims at restoring the normal anatomy of the femoral head. 

In the past, the gold standard of treatment is to place a screw to stop the femoral head from slipping further. Sometimes the other side is also done as there is upto a 50% chance of slippage on the other side.

However screwing the slip in its deformed position will result in a terrible gait and over time may result in early arthritis as result of damage from femoro-acetabular impingment.

The newer technique of capital realignment (realign the ball) has the advantage of maintaining the blood supply whilst restoring near normal anatomy. Dr Balakumar is an expert at this technique and frequently performs this technique.

Another alternative is to screw the ball in its deformed position and then perform a secondary procedure(osteotomy) to help correct the deformity. 

Arthroscopy can calso be helpful to facilitate the natural reshaping of the ball.

Overall SUFE’s are difficult condition’s around the hip that require expert opinion and management.  The main risk is AVN (loss of blood supply) to the hip, and secondary arthritis.