Slipped Upper Femoral Epiphysis


These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

This is an urgent referral - please send the child to the nearest Emergency Department.


A slipped upper femoral epiphysis (SUFE) occurs when the femoral head slips posteriorly and inferiorly through the physeal plate. The slip can be stable or unstable with an unstable slip more likely to present directly to the Emergency Department due to an inability to weight bear.

Most patients with a stable SUFE will present to their General Practitioner with hip, groin, thigh or knee pain while others will report no pain. There is often an insidious onset to the pain and there will be no recollection of a traumatic event. Earlier diagnosis and treatment may prevent escalation to an unstable SUFE which has a poorer long term prognosis.

Girls tend to develop SUFE at a younger age than boys with peak incidence in girls between the ages of 10 – 13years while in boys most are between the ages of 12 to 15 years. Many patients are overweight or obese however SUFE can also occur in normal and underweight patients. Most cases within the peak ages are idiopathic with cases outside the peak range often due to a possibly undiagnosed, endocrine or systemic medical condition.

Physically the patient will walk with an antalgic or Trendelenburg gait, will have limited flexion and internal rotation of the affected limb. The limb may also appear shorter than the healthy leg and will naturally fall into an external rotation.

For current guidelines on assessment, management and referral guidelines on Slipped Upper Femoral Epiphysis please visit HealthPathways WA

How to refer

Please send the child to the nearest Emergency Department.


  1. Allwright S, Torode I. Slipped upper femoral epiphysis/Reply. Australian Family Physician. 2010;39(6):362.
  2. Montgomery RJ. (iv) Slipped upper femoral epiphysis. Orthopaedics and trauma. 2009;23(3):169-74.
  3. Rathi RA, Khan T. Slipped upper femoral epiphysis. Orthopaedics and trauma. 2016;30(6):482-91.

Reviewer/Team: Dr Kate Stannage, Orthopaedics Dept, PCH Last reviewed: Sep 2021

Review date: Sep 2024
Endorsed by:

CPAC Date:  Sep 2021

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