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Slipped Upper [Capital] Femoral Epiphysis (SUFE / SCFE)

Slipped Upper (or Capital) Femoral Epiphysis (SUFE or SCFE respectively) predominantly affects adolescents. The proximal femoral growth plate is unstable and the epiphysis and diaphysis can slip out of the normal position, causing discomfort, pain or limping. Delayed presentation or diagnosis can lead to severe changes and risk of early osteoarthritis. 

The photograph shows severe changes of SCFE at the right hip.

The photograph below shows more subtle changes of SCFE at the right hip and highlights the importance of 'frog views'

Presentation can be described as ‘stable’ (the patient is able to walk, or can walk using aids, such as crutches), or ‘unstable’ (the patient is unable to walk at all).

SCFE can easily be missed as presentation is often with vague knee pain or insidious limp. The majority occur unilaterally, but it can be bilateral in 20-40% of cases. Risk factors for SUFE include male sex, being overweight, Down’s syndrome and hypothyroidism. Children with other rheumatic diseases can also develop SCFE - e.g acute limp and hip restriction in a patient with Juvenile Idiopathic Arthritis.

Examination include reduced range of hip movement, particularly internal rotation and abduction. The leg may appear shortened and externally rotated, or may appear externally rotated on walking.

If SCFE is suspected, urgent anterior posterior and 'frog leg' view hip radiographs should be requested.

The radiograph below (frog view) shows SCFE at the right hip

Once confirmed, urgent orthopaedic assessment is required. It is crucial to prevent further slippage to try and prevent complications occurring. The child should not be allowed to walk, and should be given crutches or a wheelchair. Surgical treatment is invariably required urgently, and the slippage should be treated with closure of the epiphysis using screw fixation. Complications include avascular necrosis, and chondrolysis (destruction and degeneration of the cartilage), which can lead to degenerative joint disease (osteoarthritis) in later life.

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