Slipped upper femoral epiphysis (SUFE) Flashcards
Define SUFE
Prevalent hip disorder in adolescents
Proximal femoral growth plate weakness allowing displacement of the capital femoral epiphysis
What is the relevant epidemiology of a slipped upper femoral epiphysis?
10 per 100,000 children annually
Inc due to rise in childhood obesity
What are the key risk factors for SUFE?
Male
Adolescent
Obesity - hypothyroidism, hypogonadism etc
Afro-caribbean and Hispanic
History of radiotherapy
History of growth hormone treatment
What is the key presentation of a SUFE?
Acute or chronic hip pain and limp -> norm unilateral and left
Referred pain to the knee
Reduced range of movement -> particularly upon hip flexion
Positive trendelenburg gait.
What are the different classifications of a SUFE?
Pre-slip - widening epiphyseal line
Acute - spontaneous
Acute on chronic
Chronic - most common, slowly progressive slip of epiphysis from metaphysis
What are the key investigations for SUFE as a differential?
Bloods - FBC, CRP and blood cultures -> to rule out infective
Bedside - joint exam
Imaging - Anterolateral and frog-leg x-rays
What is the gold standard diagnostic test for SUFE?
Anterolateral and frog-leg x-rays
Widening of the epiphyseal line and shortened displaced epiphysis
Line of Klein - lateral femoral neck upwards towards epiphysis - if does not go through epiphysis considered abnormal -> SUFE -> trethowan sign (left hip)
What is the management for a SUFE?
- pre and post operative physio
- Screw fixation of displaced epiphysis -> prompt to prevent avascular necrosis
mild to mod may be percutaneous fixation
Severe or acute -? open fiction using bone graft.
What are the complications of a SUFE?
Avascular necrosis of the femoral head
SUFE of contralateral hip
Ostearthritis - due to change in shape of the femoral head
What is the difference between stable and unstable SUFE?
Stable - abile to walk -> low risk osteonecrosis
Unstable - unable to walk -> higher risk of osteonecrosis
