Slipped upper femoral epiphysis

Question 1

What is SUFE (cause, RF, signs and sx, Ix)

Answer 1

Slipped upper femoral epithysis, or Slipped capital femoral epiphysis (SCFE)
most common hip disorder in adolescents - head of femur slips out of acetabulum

Stable —can wieght bear without support (90% of SUFE)
Unstable (unable to weight bear-bad -risk of AVN

RF -OBESITY, puberty, males

Typical -
knee, hip and/or groin pain
High BMI
EXTERNAL ROTATION OF LEG ON KNEE FLEX -key finding
Limp/gait with leg extrenally rotated
Tredeleburg poisitve- trunk lean to affected side
ALWAYS ASSESS FOR RISK OF AVN

Ix - xray main- klein lines (along suprior aspect of femoral NECK-should intersect with femoral head) ==doesnt in SUFE
Physis blurred and widnened

Question 2

Management and complications of SUFE

Answer 2

Mx
Unstable–
urgent surgery to prevent slipping -via screws, as fast as possible
low threshold for prophylactic fixation of other hip

stable -
1st line single screw fixation of epiphysis
2nd -open reduction and fixation
low threshold for prophylactic fixation of other hip

complications - osteonecrosis// Avascular necrosis (AVN) of the head -unstable SUFE
pain, restricted range of motion, esp internal rotation,

chondrolysis -cartlage loss