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Slipped upper femoral epiphysis – SUFE

  • Initial pre-referral workup

    Clinical history

    • hip, thigh or referred knee pain in age group 10 to 16 years
    • pain worse with activity and stressing hip joint
    • obesity
    • family history of SUFE

    Physical examination

    • obligatory hip external rotation during hip flexion in supine
    • acute loss of hip internal rotation
    • short leg
    • externally rotated leg
    • trendelenburg gait

    Investigations

    • plain X-ray (AP pelvis and frog leg lateral of both hips)

    In early slips, X-rays may be normal. If clinical suspicion is high, an MRI may be needed and this will be part of the paediatric orthopaedic work-up.

    GP management

    Send to ED immediately, non-weight-bearing with crutches until arrival at hospital.

    Refer parents to SUFE in children (fact sheet).

    Indications for specialist referral

    Emergency

    • all patients with confirmed SUFE should be sent to the ED immediately
    • contact orthopaedic registrar on call through Switchboard
    • do not send a fax referral as this is an emergency