SUFE Slipped Upper Femoral Epiphysis

Question 1

Hx

Answer 1

12 yr old female L insidious hip and groin pain for past 2 months. No trauma Hx or previous hip problems

Question 2

look/ inspection

Answer 2

raised BMI
Antalgic gait
Laterally rotated L foot, L quads atrophy

Question 3

feel

Answer 3

nil of note

Question 4

active movement

Answer 4

Reduced ROM of L hip [flexion & abduction]

Question 5

passive movement

Answer 5

reduced ROM of L hip [flexion & abduction]

obligatory lateral rotation of L hip on passive flexion

Question 6

special tests for this joint examination

Answer 6

nil

Question 7

other exams

Answer 7

normal distal neurovascular status

Question 8

DDx

Answer 8

SUFE
Perthes
Hip fracture

Question 9

Why is SUFE likely?

Answer 9

Hx age appropriate, insidious onset pain, absence of trauma

Exam raised BMI, reduced AROM/PROM R hip, obligatory lateral rotation on passive hip flexion

Question 10

Why is Perthes unlikely?

Answer 10

young active children [aged 4-8 yrs] M:F 5:1, generally child will have normal body habitus

Question 11

Why is Hip Fracture unlikely?

Answer 11

no Hx of trauma/ malignancy/ corticosteroids use

pain from fracture is sudden

Question 12

Investigations

Answer 12

X-ray AP Pelvis & frog leg lateral views

MRI

Question 13

X-ray AP Pelvis & frog leg lateral views

Answer 13

AP Pelvis findings
Klein’s line - line drawn along superior border femoral neck will not intersect femoral head in a child with SUFE
Epiphysiolysis - growth plate lucency/ widening
Blurring of prox femoral metaphysis [due to overlapping of metaphysic and post displaced epiphysis

Question 14

MRI

Answer 14

when radiographs are neg and preslip is suspected

findings: epiphyseal widening

Question 15

Operative tx

Answer 15

Internal fixation
Contralateral prophylactic pinning: indications = high risk patients [obese, endocrine disorders, initial slip at a younger age]