RCH logo

Clinical Practice Guidelines

Slipped upper femoral epiphysis SUFE - Fracture clinics

  • Fracture Guideline Index

    See also:  Slipped upper femoral epiphysis (SUFE) - Emergency Department

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Fracture type

    First appointment

    Subsequent review appointments (in consultant clinic)

    Discharge advice to parents

    Stable SUFE

    2 weeks for wound check

    Transfer to consultant clinic

    Protected weight bearing for 6 weeks
    • 6 weeks with x-rays
    • 12 weeks
    • 1 year with yearly review until finished growth
    • Further reviews as needed

    If only one side was pinned, patients need to return for urgent assessment if any symptoms present in the opposite hip

    No contact sports until physis is closed

    Unstable SUFE

    2 weeks for wound check

    Transfer to consultant clinic

    Non-weight bearing for a minimum of 6 weeks, dependent on severity and vascularity of the femoral head
    • A bone scan is advised early at 3 -7 days then at 6 weeks to assess blood supply to the femoral head in severe unstable SUFE
    • 6 weeks with x-rays
    • 12 weeks
    • 1 year with yearly review until finished growth.
    • Further reviews as needed

    If only one side was pinned, patients need to return for urgent assessment if any symptoms present in the opposite hip

    No contact sports until physis is closed


    2. What should I review at each appointment?

    Clinical check for gait and hip range of motion (ROM).  Radiographic review to assess for stability of the hip and any potential complications.

    3. What are the potential complications associated with this injury?

    • Osteonecrosis - the risk of ostenecrosis 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
    • Limp/abductor weakness - patients may develop abductor weakness due to a change in mechanical position of the abductor muscles
    • Leg length discrepancy - this can develop from the SUFE deformity or can result from single-sided treatment when there is still a significant amount of growth remaining on the contralateral hip

    4. When should I refer for an orthopaedic consultant opinion?

    Patients should be followed up in the consultant clinic after their initial 2-week follow-up.  Consultant opinion should be undertaken if there are any concerns with complications, progression of a SUFE, or a non-uniting SUFE.

    5. What are the indications for discharge?

    Patients should be followed yearly until growth is finished, after this they may be discharged from the consultant clinic if there are no further issues. 

    References (Outpatient 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.