/slipped-upper-capital-femoral-epiphysis-sufe-fracture Slipped Upper (Capital) Femoral Epiphysis (Sufe Fracture)

Slipped Upper (Capital) Femoral Epiphysis (Sufe Fracture)

A concise overview and management of the Slipped Upper Femoral Epiphysis or known colloquially as SUFE fractures

It is a type 1 Salter harris epiphyseal injury at the proximal hip. It is also the most common adolescent hip disorder which peaks at puberty (growth spurt). 

salter harris classification

This risk factors include:

  • Obesity (Most common)
  • Male
  • Hypothyroidism (typically bilateral SUFE, seen in 25% of cases)


Causes are varied. 

  • Genetic (Autosomal Dominant. Black ethnicity are at highest risk)
  • Cartilagenous physies hypertrophies too rapidly under the effect of Growth Hormone and the production of Sex hormones (which stabalizes physis) has not begun yet. 
  • Overweight: Mechanical stress
  • Trauma: (can cause acute slip)

Clinical Features:

  • Acute: sudden severe pain with limp
  • Chronic: (typical): presents with groin pain or/and anterior thigh pain. Knee pain may be present.
  • Positive Trendelenburgs Test on affected side, due to weakness of the gluteal muscles. 
  • Tender over joint capsule
  • Restricted Internal Rotation, Abduction and flextion
    • Whitman's Sign: Obligatory External Rotation during passive flexion of the hip.
  • Loder Classification: Stable vs Unstable (has prognostic value)
    • Unstable means the patient cannot ambulate even with crutches.




  • Frog Legs
  • Anterior Posterior (AP) (Both Hips)
  • Lateral (both hips)

These would show posterior and medial slips of epiphysis, disruption of Klein's Line. AP view may also show widened/lucent growth plate compared to opposite side.

Kleins line: On AP view, draw line along supero-lateral border of femoral neck, it should cross at least some portion of the femoral epiphysis. Suspect SUFE if not.

Kleins line



  • Mild/Moderate Slip:
    • Stabalize physis with pins in current position
  • Severe Slip: ORIF or pin physis without reduction and osteotomy (cutting bone) after episphyseal fusion.


  • Avascular Necrosis (half of unstable hips, see Loder Classification)
  • Chondrolysis (loss of articular cartilage, resulting in narrowing of the joint space
  • Pin Penetration
  • Premature Osteoarthritis (OA)
  • Loss of Range of motion