Slipped Upper Femoral Epiphysis

Question 1

Define slipped upper femoral epiphysis.

Answer 1

Metaphysis displaces anteriorly + superiorly, externally rotates

Causing displacement of the femoral head epiphysis postero-inferiorly

Most common hip disorder in adolescents.

Question 2

What are Klein lines?

Answer 2

Klein lines are drawn along the superior cortex of the femoral neck.

Normal: intersects epiphysis

Abnormal: does not intersect epiphysis, as femoral neck has moved proximally + anteriorly relative to the epiphysis

Question 3

5 RFs for slipped upper femoral epiphysis.

Answer 3

Obesity

Metabolic endocrine disease (Panhypopituitarism, hypothyroidism, renal osteodystrophy)

M > F

Age 10-15 (growth spurt)

African-Americans > Hispanic > Caucasian

Question 4

What are the symptoms of a slipped upper femoral epiphysis?

Answer 4

Medial knee, hip, groin +/- thigh pain (may be referred)

Chronic, persistent Sx or acutely following trauma

Question 5

4 signs of a slipped upper femoral epiphysis?

Answer 5

Loss of internal rotation of the leg in flexion

Bilateral slip in 20%

Limp, walk with leg externally rotated

Trendeleburg gait +ve (lean on 1 side)

Question 6

What imaging is diagnostic of slipped upper femoral epiphysis?

Answer 6

Bilateral AP Hip: Klein’s line doesn’t intersect femoral head

Lateral (frog leg) X-Rays: Klein’s line doesn’t intersect + Bloomberg’s sign +ve (blurred/ widened physis)

Question 7

What is the management for an unstable slipped upper femoral epiphysis?

Answer 7

Urgent surgical repair

Prophylactic fixation of contralateral hip

Question 8

What are the management options for a stable slipped upper femoral epiphysis?

Answer 8

1. In-situ screw fixation + prophylactic fixation of contralateral hip.
2. Open reduction + internal fixation with surgical hip dislocation + Prophylactic fixation of contralateral hip.
3. Bone graft epiphysiodesis + prophylactic fixation of contralateral hip.

Question 9

What is the management for an ongoing or late presented slipped upper femoral epiphysis?

Answer 9

Corrective surgery

Question 10

4 complications associated with a slipped upper femoral epiphysis

Answer 10

SUFE in contralateral hip

Osteonecrosis

Chondrolysis

Late deformity

Question 11

What 5 factors contribute to prognosis of a slipped upper femoral epiphysis?

Answer 11

Initial severity of slip

Success of surgery

Avoidance of serious complications

Underlying disorders

Bilaterality.

Question 12

What further Ix may be considered in SUFE?

Answer 12

Metabolic panel

Serum TFTs

Serum growth hormone