Slipped Upper Femoral Epiphysis

Slipped upper femoral epiphysis (SUFE) is also known as slipped capital femoral epiphysis (SCFE). It is where the head of the femur is displaced (“slips”) along the growth plate.

It is more common in boys and typically presents aged 8 – 15 years, with the average age of 12 in boys. It presents slightly earlier in females, with an average age of 11 years. It is more common in obese children.



The typical exam presentation is an adolescent, obese male undergoing a growth spurt. There may be a history of minor trauma that triggers the onset of symptoms. Suspect SUFE if the pain is disproportionate to the severity of the trauma.

Presenting symptoms can be vague. These can be:

  • Hip, groin, thigh or knee pain
  • Restricted range of hip movement
  • Painful limp
  • Restricted movement in the hip

When examining the patient, they will prefer to keep the hip in external rotation. They will have limited movement of the hip, particularly restricted internal rotation.



The initial investigation of choice in SUFE is xray.

Other investigations that can be helpful in establishing the diagnosis are:

  • Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
  • Technetium bone scan
  • CT scan
  • MRI scan



Surgery is required to return the femoral head to the correct position and fix it in place to prevent it slipping further.


Last updated January 2020
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