Slipped Upper Femoral Epiphysis (SCFE or SUFE) is a very common condition in the rapidly growing child. It results in effect a slippage of the femoral head (ball) from the rest of the femur. It is like a fracture through the ball/neck junction, but it behaves very differently.
This is due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.
The condition is diagnosed based on a careful history, physical examination, observation of the gait/walking pattern, and X-rays of the hip. The X-rays help confirm the diagnosis by demonstrating that the upper end of the thigh bone does not line up with the portion called the femoral neck.
SUFE’s usually occur during rapid growth in puberty between the ages of 8 till 15. The child usually complains of knee pain or hip pain and can often present with a limp. As it becomes more severe the slip can result in a shortened leg and with a twist outwards.
A SUFE is a orthopaedic emergency and needs urgent treatment. Mr. Balakumar is one of the surgeons in Australia who has been trained in a novel technique that aims at restoring the normal anatomy of the femoral head whilst protecting the blood flow to the femoral head.
In the past, the gold standard of treatment is to place a screw to stop the femoral head from slipping further. Sometimes the other side is also done as there is up to a 50% chance of slippage on the other side.
However screwing the slip in its deformed position will result in a terrible gait and over time may result in early arthritis as result of damage from femoro-acetabular impingement. There is also a 25-50% chance of loss of blood supply to ball of the hip resulting in early arthritis. This may often result in needing further surgery to the hip in either a fusion or replacement.
The newer technique of capital realignment (realign the ball) has the advantage of maintaining the blood supply whilst restoring near normal anatomy. Mr. Balakumar will offer this treatment to the appropriate patient.
Another alternative is to screw the ball in its deformed position and then perform a secondary procedure (osteotomy) to help correct the deformity.
Arthroscopy can can also be helpful to facilitate the natural reshaping of the ball.
Overall SUFE’s are a difficult condition’s around the hip that require tertiary level opinion and management. The main risk is avascular necrosis or AVN (loss of blood supply) to the hip, and secondary arthritis.
[Updated August 2014]
64 Chapman Street
North Melbourne VIC 3051
Ph: (03) 9329 5525
Fax: (03) 9329 4969
Melbourne Orthopaedic Group
33 The Avenue
Windsor VIC 3181
Ph: (03) 9573 9659
Fax: (03) 9521 2037
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© 2012-2014 Jit Balakumar - Paediatric & Adult Orthopaedic Surgeon, Melbourne
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