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