Definition
S.U.F.E? These letters stand for Slipped Upper
Femoral Epiphysis.
In children, there are growth plates - epiphysis at the junction
between the head and neck of the thigh bone (femur) and also at the
lower end of the bone. In later childhood, for some unknown reason,
the head of the femur may slip downwards and backwards, like ice
cream partially sliding off a cone.
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Radiographic Appearance
The lines drawn along the superior border of the proximal
femur metaphysis (the Klein line) should intersect part of the
proximal femoral epiphysis.
In other subtle cases, the physis may appear to be thinner than the
normal side. This can occur if the slip occurs posteriorly. Early
slips can be difficult to demonstrate radiographically. AP views of
the hips can only detect inferior and medial slips. Early slips tend
to slip only in the posterior direction. Posterior slips are best
seen on lateral views of the hips, but these are difficult to
obtain. CTscanning can be helpful for orthopedic surgeons,
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Pathology
SUFE is a slow separation and slippage of the growth plate of the
femur at the hip joint. The head of the femur bone will usually slip
backward and inward relative to the shaft. The deformity of the hip
joint causes a loss of motion and abnormal stress in the joint which
can lead to a limp. SCFE affects approximately 1 -3 per 100,000
people, occurring in boys twice as often as girls. The slip usually
occurs in early adolescence (12 -15 years in boys, and 10 - 13 years
in girls). The opposite hip will slip in roughly 25% of affected
children within 18 months of the first one. The exact cause of SCFE
is unknown but is typically found in children who are somewhat obese
(greater than the 95th percentile for their weight). For children
under the age of 10 years, endocrine problems (such as thyroid) are
believed to contribute to weakening of the growth plate.
The symptoms of a slip can develop chronically, acutely, or
acutely in a chronic situation. Your child may develop a painless
limp over several weeks or months, or more commonly may complain of
knee pain referred from the hip area. Due to the nerve supply to the
hip joint, problems in the joint can present with pain in other
parts of the leg such as the thigh or knee. If a child is able to
walk the slip is considered stable; however, sometimes the slip
develops suddenly and your child cannot walk or stand due to pain
producing an unstable slip. Over time the hip slowly loses the
ability to rotate inward and to flex, causing the child to walk in
an abnormal manner, using the upper body to say to compensate for
hip joint weakness.
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Treatment:
Bed rest is essential to prevent further slip. An
operation is necessary to prevent slipping of the displaced head of
the femur. A cut (approximately 8cm long) is made in the outer side
of the upper thigh and metal pins are placed through the femoral
neck and into the head of the femur. A dressing covers the wound.
The pins will be removed after approximately 12 months. This will
entail a one or two night stay in hospital.
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| Image Fig 1
(http://gait.aidi.udel.edu) 1 AP (Widened rt side
joint space)
1b AP (Widened Lt side
joint space)
2 "Frogs" lateral
3 Pinned
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Useful Link
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| http://www.hawaii.edu/medicine/pediatrics/pemxray/v2c10.html |
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