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HealthInfo Waitaha Canterbury

Slipped upper femoral epiphysis (SUFE)

Paheketanga pūkaka o runga

A normal hip joint and one with a SUFE. The ball of the thigh bone has slipped down, with a gap between the ball and the rest of the thigh boneA slipped upper femoral epiphysis (i-piff-i-sis) is a condition involving the hip joint of a tamaiti (child) that is most common just before or during adolescence. It is also called a SUFE.

The hip joint works as a ball and socket, with the top of the thigh bone (femur) shaped like a ball that fits into a socket in the pelvis.

A SUFE happens when the growth plate (called the epiphyseal plate) in the ball at the top of the thigh bone is weak. As a result, the ball of the thigh bone slips downward and backward. The illustration shows what this looks like.

We do not know exactly what causes this, but it may be linked to increased weight and puberty hormones while the tamaiti child is growing very quickly. It usually doesn't happen because of an injury. Although it normally happens in just one hip, occasionally it can happen in both.

Symptoms of a SUFE

Often the symptoms of a SUFE develop slowly, over several months. At first it may seem as though your tamaiti has a pulled muscle in their hip, thigh, or knee. Or the symptoms can happen suddenly, and may be the result of an accident. In these cases your tamaiti might have pain in their knee or thigh and may not be able to walk. Some tamariki (children) only have knee pain even though the condition affects their hip.

Your tamaiti may also have:

Diagnosing a SUFE

If you think your tamaiti has a SUFE, it's important to get it treated before it gets any worse. The doctor your child sees will ask questions about their symptoms, examine their hip and leg, and arrange an X-ray. Your tamaiti may also need a CT scan or bone scan.

Treating a SUFE

The treatment your tamaiti has will depend on how bad the slip is. Most tamariki (children) need an operation to put screws into the ball of their thigh bone, to keep their hip stable. After the operation, they will have an X-ray to make sure the screws are in the right place. Occasionally a tamaiti needs the other hip treated to stop it from happening on the other side as well.

Your tamaiti will need to stay at least one to two nights in hospital. They will be able to go home once they feel comfortable and are safe using crutches or a wheelchair, as they will not be able to stand with all their weight on the affected side for about six weeks.

Once the growth plate closes (after they have stopped growing) they may need another operation to take the screws out.

Helping my child with a SUFE

Boy using crutches to avoid putting any weight on SUFE-affected hip jointThere are several things you and your tamaiti can do to make sure their bone heals as well as possible.

For the first 24 to 48 hours after they come home apply ice to the area for 20 minutes at a time. This helps to ease the pain and reduce swelling. Make sure you wrap the ice in a damp towel or cloth, and do not apply it directly to their skin, or you could cause an ice burn.

They will need simple pain relief, which the hospital will supply. Make sure they take it regularly, but never give them more than the recommended dose for their weight, which will be printed on the medication packet. Do not give them anti-inflammatory pain relievers such as ibuprofen (Nurofen), as this may slow down their bone healing.

Encourage your tamaiti to gently move their leg and hip in a way that is comfortable for them.

After six weeks of not putting any weight on the affected leg, your tamaiti can start to put some weight on it, with support, for another six weeks. Then they can put full weight on it as long as it doesn't hurt.

At this stage they can return to low-impact, non-contact activity such as walking, swimming, and cycling. But they should avoid contact or high-impact sports until they have stopped growing, as until then there is a risk of the SUFE happening again.

After care

After their operation, your tamaiti will have regular X-rays to make sure their bone is healing well.

While most tamariki do not have any long-term complications from a SUFE, for a few the slip can be severe. This can cause significant changes to their hip joint and lead to a deformed leg, continuing pain, or early-onset arthritis. Therefore, it's important to get your tamaiti treatment early and keep all follow-up appointments, so any issues can be caught and treated early.

SUFE can cause a variety of issues for your tamaiti and sometimes further surgery will help. Their surgeon will discuss these with you.

Written by HealthInfo clinical advisers. Last reviewed June 2022.

Sources

See also:

Growth plate injuries

Page reference: 390109

Review key: HIBOW-85151