In Situ Fixation of Slipped Upper Femoral Epiphysis

Indications

Slipped Upper Femoral Epiphysis | SUFE, radiograph of a slipped capital femoral epiphysis
Radiograph of a slipped capital femoral epiphysis. Image by Dr. Jochen Lengerke, Wikimedia Commons, CC0.
  • Stable SUFE, able to bear weight (Loder)
  • Unstable SUFE as an urgent procedure
  • Prophylactic contralateral fixation with endocrine disease, age under 10 or high risk
  • Severe deformity may later need a corrective osteotomy or surgical dislocation

Position

  • Supine on a radiolucent or fracture table, no forced reduction
  • Image intensifier for AP and true lateral views

Operative Steps

  1. Do not manipulate a stable slip
  2. Start point on the anterior femoral neck for a posterior slip
  3. Single cannulated screw perpendicular to the physis into the centre of the epiphysis
  4. At least four threads across the physis
  5. Screw tip short of the subchondral bone
  6. Rotate the leg under live fluoroscopy to exclude joint penetration
  7. Unstable slips, gentle positional reduction and capsular decompression are considered
  8. Use a partially threaded 6.5 or 7.3 mm screw

Postoperative Care

  • Protected weight bearing, longer for unstable slips
  • Follow both hips to skeletal maturity
  • Radiographs at 6 weeks and every few months until physeal closure
  • Avoid contact sport until the physis begins to close
  • Investigate endocrine disease in atypical patients

Complications

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.