SUFE in Children

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A slipped upper femoral epiphysis (SUFE) is a condition that involves the femur bone located in the thigh and affects the hip joint. This can cause the femur to fracture and become painful as the bones grate against each other.

Christopher Bache, consultant orthopaedic surgeon, explains: "SUFE tends to occur during adolescence (age 13-16 boys, 12-14 girls), with boys more commonly affected than girls."

What Causes an SUFE?

The hip joint has a ball and socket formation, with the top of the femur bone forming the ball part. Underneath this is the growth plate - a piece of growing tissue that changes as a child grows and develops, allowing the bones to lengthen. This is known as the epiphyseal plate. 

Christopher explains: "SUFE occurs when the head of the femur (epiphysis) slips backwards through the growth plate (physis). The physis is weaker during adolescence predisposing to slippage. Certain conditions also predispose particularly hypothyroidism."

What are the Symptoms of SUFE?

A child with SUFE could be suffering from the following symptoms, so if you recognise any of these in your child it is worth taking them for a consultation with a GP. 

  • Pain in the groin, hip, knee, or thigh 
  • A limp or holding of their leg in an unusual position when resting
  • Some shortening of the leg that is affected
  • The affected leg may turn outwards
  • Reduced movement in the hip (hip joint) 

A child suffering from SUFE could also feel like they’ve pulled a muscle in their hip, thigh, or knee. If this happens when your child hasn’t been doing any strenuous activity, or doesn’t improve in a matter of days, it’s important to get them seen by a GP. 

Christopher adds: "Patients classically complain of groin pain, which is worse on exercise. However, importantly, the pain can be felt in the thigh or knee. This can result in missed diagnosis as pathology in the knee is erroneously suspected. It is mandatory to exclude hip pathology in an adolescent patient presenting with thigh or knee pain.

"As the condition progresses, the slip become worse, resulting in a limp and a shortened leg (by a few centimetres). The leg becomes externally rotated. Sometimes the slip is acute (rapid) resulting in a very painful hip that the patient cannot walk on."

How is SUFE Diagnosed?

It’s important that your child is diagnosed with SUFE early in order to treat the condition before it gets worse.

Christopher explains how SUFE is diagnosed: "SUFE is diagnosed with a plain anteroposterior pelvic (AP) X-ray. However, it is imperative that a lateral view (frog lateral) is performed in addition since early slips are frequently not visible on the AP X-ray."

How to Treat SUFE

In all cases of SUFE, your child will need surgery to fix the issue. The extent of the surgery needed will depend on how much the femur has slipped from where it should be. However, most SUFE corrective surgeries involve inserting a screw into the head of the femur to keep it stable and in place. 

Christopher said: "The treatment of SUFE is surgical. When detected early, the slip is mild (grade 1) and treated by pinning the slip in situ. This stops the slip from progressing. The operation is done through a small 2cm incision passing a single screw across the growth plate. The short and long-term results are good. More significant slips (grades 2 and 3) can also be pinned in situ. The short-term results are good but the leg remains short with a restricted range of movement. Patients will usually develop pain due to impingement over the course of 10-15 years and osteoarthritis will ultimately occur in most patients.

"As a result of the poor long-term results for grade 2 and 3 slips, operations to reorientate the anatomy have become more popular in recent years. These operations are major undertakings requiring division of the neck of the femur (osteotomy). Risks are significant and rehabilitation is prolonged.

"The emphasis is on detecting the condition early since treatment is much easier and more effective."

Avoid letting your child stand and put weight on the affected leg(s) until the SUFE has been corrected with surgery. Unfortunately, your child will need bed rest or use a wheelchair during this time.

What Should I Expect With my Child's Surgery?

Your child will be placed under a general anaesthetic, so will be asleep throughout the operation. Once the surgery is complete, radiographers will then take an X-ray to ensure that the screws have been positioned correctly and that they will work effectively to correct the SUFE. 

In some cases, the unaffected hip joint may also be treated to prevent this from slipping in future years. This will be discussed with you and your child at their consultation.

Your child will need to stay overnight in the hospital for at least the first night following the surgery. Once they are comfortable using their wheelchair or crutches, they will be able to return home to recover. You and your child will both be taught how to safely use the crutches or wheelchair provided and also be taught a care routine.

Will my Child Need Physiotherapy Sessions After Surgery for SUFE?

Physiotherapy sessions can begin straight after surgery and are a great way to help build your child’s strength up in their leg. It will also teach them how to avoid causing unnecessary pain during the healing process. 

Physiotherapy can help to reduce pain, increase range of movement, improve balance and gait patterns, and also help your child return to their normal daily activities. 

The treatment given will vary from patient to patient depending on the severity of your child’s SUFE, but usually, physio sessions will involve balance and strengthening exercises, learning how to correctly use walking aids, and possibly heat and ice therapy. 

How Common is SUFE?

SUFEs can affect up to every 10 per 100,000 of the population, affecting more boys than girls. 

Can SUFE be Hereditary?

Certain disorders can make your child at higher risk of developing an SUFE. These include hypothyroidism and osteodystrophy. This means that if either of these conditions runs in your family, your child could be more likely to develop an SUFE. 

Talk to Us

If your child has experienced an SUFE and was misdiagnosed, or has been treated negligently, speak to one of our expert solicitors today and find out if you are eligible for a claim. Contact us on 0345 872 6666, or fill in our online form to request a call back.

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