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It is common to see a child with months of symptoms having been treated for knee pain eventually diagnosed with a late SUFE
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5. What radiological investigations should be ordered?
AP and frog lateral pelvis x-rays of both hips should be ordered. In an unstable, acute SUFE, a frog lateral view is not obtained preoperatively in order to avoid causing pain and because of the potential for displacement of the SUFE. A cross-table lateral x-ray, however, can be ordered.
6. What do they look like on x-ray?

Figure 1: AP and lateral x-rays of a 10 year old boy demonstrating a SUFE. The SUFE is best seen laterally. This child presented with chronic knee pain.
7. Do I need to refer to orthopaedics now?
All patients with a SUFE or concern for a SUFE need urgent orthopaedic assessment.
8. What is the usual ED management for this injury?
All patients with a SUFE need surgical stabilisation. The patient needs to be kept non-weight bearing, and admitted for surgical treatment.
9. What advice should I give to parents?
If the child does have a SUFE, he or she will need surgery to stabilise the hip and must be admitted to hospital.
10. What are the potential complications associated with this injury?
- Osteonecrosis - the risk is up to 50% in an unstable SUFE, even with treatment
- Chondrolysis - this can result from the process of the SUFE itself, but more commonly it is from unrecognised screw/pin penetration from surgical stabilisation. The overall incidence of this is approximately 7%
- Osteoarthritis - patients with a moderate or severe SUFE have higher risk of early degenerative joint disease
- Impingement - patients with a severe SUFE have a risk of deformity through the femoral neck when the SUFE is stabilised and healed. This can cause femoral acetabular impingement, and may require further surgical treatment to correct this
See fracture clinics for other potential complications.
References (ED setting)
Aronsson DD, Loder RT, Breur GJ, et al. Slipped capital femoral epiphysis: current concepts. J Am Acad Ortho Surg 2006; 14: 666-79.
Weigall P, Vladusic S, Torode I. Slipped upper femoral epiphysis in children: delays in diagnosis. Aust Fam Physician 2010; 39(3): 151-3.
Kay RM. Slipped femoral capital epiphysis. In Lovell and Winter's Pediatric Orthopaedics, 6th Ed, Vol 2. Morrissy RT, Weinstein SL (Eds). Lippincott, Philadelphia 2006. p.1085-124.