SUFE

Clinical image

Radiograph showing slipped capital femoral epiphysis. Source: Wikimedia Commons — Dr. Jochen Lengerke; CC0 1.0. Image binary is embedded locally in this package; original source and licence are retained.

Define

• Disorder of proximal femoral metaphysis
• That leads to slippage of the metaphysis anteriorly and superiorly
• relative to epiphysis, which remain anatomically positioned

M/C

• Boys
• Increased weight
• Hormonal conditions
  • Hypopitutary
  • Hypothy
  • Hypogonadism
  • Rickets

C/F

• Overweight boy
• Thigh/knee pain
• Limping
• minor trauma
• 11-14 y

C/E

• Short and ER
• FADER position
• F, abd, IR restricted
• Additional ER if hip is flexed further

Inv

• X ray
• Klein line
• Decreased ep height
• Widening of physis
• Remodeling changes , sclerosis

Klein line

Classification

• Functional

  • Stable
  • Unstable

• Lodder, 55 slips in 54 children, multi centre

  • avn 47% in unstable hip

• Cronological

• a/c

  • <3 weeks
  • abrupt

• c/c

  • 3weeks

  • gradual

• a/c on c/c

  • 3weeks symptoms

  • sudden increase in pain

Grading

• Southwick
• Laterl view
• diff b/w two sides
• Grade 1: <30 degree
• 2: 30-50
• 3: >50

Treatment

• Aim
  • prevent any progression without complication
• Stable or chronic: PIS
• Unstable and acute:
  • PIS difficult
  • Risk of AVN
  • OR
    • Fish sub capital
    • Dunn trochanteric
    • Ganz

Uglow and clark

Key points

PIS

• More anterior entry

• 6.5 mm fully threaded reverse cutting screws

• Use fluoroscopy to avoid blind spot

• No more than 3-5 threads, 5mm below subchondral

• PWB to FWB

Timing

• Stable: ASA safly possible
• Unstable
  • Lownders et al:
    • AVN decreases if done with in 24 hours
  • Peterson
    • Less AVN 24 hours
  • Loder
    • Less AVN with in 48 hours

Contralateral

• Symptomatic: fix
• Asymptomatic: fix if
  • < 10 y
  • endocrine
  • poor compliance
  • nature of current slip

Compli

• AVN
• Chondrolysis: rapid and progressive loss of cartilage
• Deformity
• OA
• LLD