Synopsis
Recognise an adolescent proximal-femoral physeal slip from hip or referred knee symptoms, stop further displacement immediately and coordinate urgent in-situ stabilisation and contralateral surveillance.
- SUFE usually affects an adolescent and may present as isolated thigh or knee pain; always examine both hips when the knee findings do not explain the limp.
- The affected leg rests externally rotated and hip flexion produces obligatory external rotation with loss of internal rotation.
- Stable means the child can bear weight with or without crutches; unstable means they cannot, and the osteonecrosis risk is substantially higher.
Key red flags
An adolescent with hip, groin, thigh or unexplained knee pain and an out-turned foot has SUFE until adequate bilateral hip imaging excludes it.
Investigation priorities
Identify physeal widening, epiphyseal displacement, asymmetry and contralateral disease.
Management branches
An adolescent has compatible hip, thigh or knee pain, external rotation or limited internal rotation.
- Make the child strictly non-weight-bearing and use bed, trolley or wheelchair transfer.
- Give age- and weight-appropriate analgesia and document hip, knee and distal neurovascular findings without forceful motion.
Imaging confirms a slip and the child could bear weight with or without crutches before assessment.
Key medicines
Paracetamol during non-weight-bearing assessmentPrescribe the current BNFC age- and weight-based oral dose, recording the exact milligrams, formulation volume, minimum interval and daily maximum for that child.
Ibuprofen for selected stable childrenUse the BNFC age- and weight-specific oral dose for a short course when hydration, kidney function, bleeding risk and perioperative plan permit it.