Slipped Upper Femoral Epiphysis (SUFE)
Overview
Slipped upper femoral epiphysis (SUFE, also called slipped capital femoral epiphysis) is displacement of the proximal femoral epiphysis relative to the femoral neck through the growth plate. It typically occurs in early to mid-adolescence and requires urgent orthopaedic assessment. Delayed or inappropriate management increases the risk of avascular necrosis (AVN), chondrolysis and early osteoarthritis.
Epidemiology and risk factors
- Typical age: approximately 10-16 years (peri-pubertal).
- Strongest associations: obesity and rapid growth during puberty.
- Other associations: endocrinopathies, including hypothyroidism and growth hormone abnormalities, and chronic renal disease.
- Laterality: may be unilateral or bilateral; the contralateral hip is also at risk and should be assessed.
Pathophysiology
During the adolescent growth spurt, the physis is relatively weak and subject to shear forces. Hormonal and metabolic factors may further reduce physeal resistance, allowing the femoral neck and metaphysis to displace relative to the epiphysis.
Clinical presentation and examination
- Typical presentation: painful limp with groin or thigh pain, frequently referred to the ipsilateral knee.
- Pain onset: may be acute after minor trauma or insidious with a progressive limp.