Slipped upper femoral epiphysis (SUFE)

  • A slipped upper femoral epiphysis (SUFE) is a condition involving the hip joint. The hip joint works as a ball and socket. The very top of the femur (thigh bone) forms the ball (also called femoral head), and beneath this ball lies a growth plate (an area of growing tissue that allows the bones to lengthen, also called the epiphyseal plate).

    With a SUFE, this growth plate suffers a form of fracture, and the head of the femur slips out of position. 

    A child with a SUFE may feel like they have a pulled muscle in their hip, thigh or knee. 

    The exact cause of this condition is not known, but there may be a link between increased weight and puberty hormones. A SUFE is not usually associated with an injury. 

    It is important to get an early diagnosis and treatment before the slip gets worse. Treatment always involves surgery.

    Signs and symptoms of a SUFE

    The symptoms often develop slowly over several months, but can also occur suddenly. If your child has a SUFE, they may have: 

    • pain in their groin, hip, thigh and/or knee – some children only have knee pain, even though the condition affects the hip
    • a limp, or holding their leg in an unusual resting position
    • reduced movement of their hip joint
    • a slight shortening of the affected leg.

    When to see a doctor

    If your child has groin, hip, thigh and/or knee pain, see your GP.

    If your child has all of the symptoms of SUFE (above), make sure they do not place any weight on either leg (they should be carried, or use a wheelchair), and go to a hospital emergency department as soon as possible.

    Diagnosis of SUFE is usually made by physical examination of hip movement and an X-ray. Sometimes further imaging (e.g. an MRI) is also needed to diagnose a SUFE. 

    Treatment for SUFE

    In all cases, children with a SUFE need surgery. It is very important that your child avoids standing up and placing weight on their leg until the SUFE is corrected surgically, so until then they will need to use a wheelchair or have bed rest.

    The type of operation will depend on the how far the head of the femur has slipped, but most operations will involve screws being put into the head of the femur to make sure it is stable.

    The operation will take place while your child is asleep under a general anaesthetic. After the surgery, an X-ray is taken to make sure the screws are in the right place.

    Your child may need to have their unaffected side treated as well, to prevent that side slipping in the future. Your orthopaedic surgeon will discuss this with you.

    Your child will need to stay at least one to two nights in hospital. They will be able to go home once they feel comfortable and safe using crutches or a wheelchair.  The hospital staff will teach you and your child how to use the crutches or wheelchair safely.

    Care at home

    Your child will have a small wound on the side of their leg, with a waterproof dressing over it.  Nurses will give you instructions on how to care for the dressing after your child has returned home.  Ask for more information if you're not sure.

    Contact the hospital or go to the GP or nearest hospital emergency department if your child's wound seems to be infected. An infected wound may appear red or swollen, be smelly or leak fluid, and your child may have a fever. See our fact sheet Wound care.

    Most children need some regular pain relief, such as paracetamol, for the first few days after surgery. Ask the nurses, doctors or pharmacist about what to give and how often.

    Your child won't be able to stand with all their weight on the affected side for about six weeks, and will need to use crutches or a wheelchair for that time.  

    Your child will need to stay home from kindergarten or school until advised by your child's surgeon. Your doctor will also advise you when they can return to sport and other activities.


    Your child may need to go back to the hospital one to two weeks after going home for a wound check and an X-ray. Some children can wait until six weeks after going home – doctors will discuss the follow-up plan with you before you leave the hospital.

    The screws in your child's hips can be taken out once the growth plate has healed, and no contact sport is allowed until that time.

    Key points to remember

    • With a SUFE, the growth plate at the top of the thigh bone is fractured, and the ball at the top of the bone slips out of position.
    • The symptoms of SUFE seem like a pulled muscle or strain of the hip, thigh or knee.
    • Treatment is usually an operation to insert metal screws that help keep the hip stable.
    • Your child will need to keep their weight off their affected leg until after their SUFE surgery.
    • Some children may need to have the unaffected side treated as well to prevent future slipping.

    For more information

    Common questions our doctors are asked

    Will my child's shorter leg catch up to the other leg after surgery or will it be shorter permanently?

    Your child's affected leg is no shorter than the other – it only appears that way due to the SUFE. Once the bones are returned to their normal position, there is no difference between leg lengths.

    Will my child need to have physiotherapy after the operation?

    Most children do not require physiotherapy following SUFE surgery. They will slowly return to their normal activities, as guided by their doctor.

    Developed by The Royal Children's Hospital Orthopaedics department. We acknowledge the input of RCH consumers and carers.

    Reviewed May 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

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