SUFE Flashcards
A 16 year old obese boy presents with pain in the right knee and hip. He walks into your practice with a limp. How would you assess and manage this child?
Impression
Most likely SUFE
- One of most common hip disorders in adolescence.
- Due to poor cartilaginous maturation and endochondral ossification in the growth plate; ultimately leads to displacement
SUFE complications that can occur
- osteonecrosis
- Chondrolysis: narrowing of joint space and loss of articular cartilage
DDx
- rule out septic arthritis
- overuse: osgood-schlatters disease
- MSK: stress fracture, ligamentous injury, other fractures, meniscal injury, bursitis, tendonitis, etc
- neoplastic
Goals
- targeted Hx/Ex/Ix, rule out red flag differentials and utilise imaging of the affected hip
- urgent ortho referral
SUFE - History
History
- PC: pain, altered gait, worsened by physical activity, reduced ROM, inability to weight bear, time-period of symptoms
- REDS: fever, chills, rigors, weight loss, other recent illnesses
- Risks: obesity, family history, syndomres (down)
- paeds history
SUFE - Examination
Examination
- Vitals
- General appearance
- Hip exam: inspection (atrophy, held in ER, erythema, swelling), pain, temperature, ROM, trendelenburg (positive in gluteal muscle wasting).
- Knee exam: should be normal in SUFE; knee pain is just referred from the hip.
SUFE - Investigations
Investigations
Diagnostic;
- Hip X-Ray; AP and Lateral.
o looking for widening and displacement of the physics
- Consider MRI/CT hip for more high-res images and for surgical planning
Ancillary
- Ix for ?septic arthritis - joint aspirate, bloods.
- pre-op bloods
SUFE - management
Management
- Ortho referral for urgent surgical repair
Definitive
- single, cannulated screw placed in centre of physics to prevent further slippage and avoid complications
Supportive
- keep non-weight bearing whilst waiting for theatres
- limited weight-bearing with crutches for 6-8 week spost-op
- appropriate F/U with ortho
- appropriate analgesia
