Slipped Upper Femoral Epiphysis Flashcards
Define slipped upper femoral epiphysis.
Most common hip disorder in the adolescent age group. Occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. It is the metaphysis that displaces anteriorly and superiorly, leading to the slipped state.
What are Klein lines?
Klein lines are drawn along the superior cortex of the femoral neck. Plain anteroposterior/frog-leg lateral radiographs show the Klein line not intersecting the femoral head in hips with slipped upper femoral epiphysis.
Explain the aetiology/risk factors for slipped upper femoral epiphysis.
Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy. A period of rapid growth in adolescence may also weaken the epiphyseal plate.
Summarise the epidemiology of a slipped upper femoral epiphysis.
Incidence 4 times higher in African-Americans and 2.5 times higher in Hispanic than in white people. Males are twice more likely to be affected than females.
What are the symptoms of a slipped upper femoral epiphysis?
Typical presenting features include medial knee, hip, groin and/or thigh pain. Pain may be referred to these regions. Onset may have been acute or insidious. A history or trauma from falls or a sport injury may be elicited.
What are the signs of a slipped upper femoral epiphysis?
In patients 90th percentile, the child has a significant risk factor for SCFE. Obligatory external rotation is present when the hip joint is flexed. Passive and active flexion of the hip should be conducted. The affected hip tends to go into external rotation during flexion.
Range of movement is typically restricted. The patient may limp and gait is characteristic for the patient to walk with their leg externally rotated. Observational gait analysis is therefore recommended. Trendelenburg’s test is positive. The test is performed by the child standing on the affected leg with the knee flexed and the hip extended. The trunk typically leans towards the affected side.
What are appropriate investigations for a slipped upper femoral epiphysis?
Bilateral antero-posterior x-rays Frog-leg lateral X-Rays
Consider: Metabolic panel, Serum TFTs, Serum growth hormone
What is the management for an unstable slipped upper femoral epiphysis?
Urgent surgical repair + Prophylactic fixation of contralateral hip
What is the management for an stable slipped upper femoral epiphysis?
In-situ screw fixation + prophylactic fixation of contralateral hip.
Open reduction and internal fixation with surgical hip dislocation + Prophylactic fixation of contralateral hip.
Bone graft epiphysiodesis + prophylactic fixation of contralateral hip.
What is the management for an ongoing or late presented slipped upper femoral epiphysis?
Corrective surgery
What are complications associated with a slipper upper femoral epiphysis?
Chondrolysis
Late deformity
SUFE in the contralateral hip
Osteonecrosis
What is the prognosis of a slipped upper femoral epiphysis?
Prognosis is related to the initial severity of the slip, success of surgery, avoidance of serious complications, underlying disorders and bilaterality.
