Slipped Upper (Capital) Femoral Epiphysis (Sufe Fracture)
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).
This risk factors include:
- Obesity (Most common)
- 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)
- 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.
- 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