Slipped upper femoral epiphysis (SUFE)

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Right sided hip pain with no specific traumatic precipitant. Doesn't particularly like sport.

Patient Data

Age: 12 years
Gender: Male

On the AP view there is very little to see. The line of Klein intersects the epiphysis and the femoral heads are symmetrical. On the frog-leg view, there is clear abnormality on the right with slip of the upper femoral epiphysis (SUFE).

Case Discussion

Features here are of a relatively typical case of SUFE. Some institutions only perform a frog-leg radiograph in patients between the age of 8 and 14 and in any case, it is the view to look at first. In patients of this age, never be satisfied with a single AP view.

These patients need urgent referral to the orthopedic surgeons and need to be on bed rest so that they don't make the slip worse. Surgical treatment is to pin the epiphysis in place (usually without manipulation) and since 10% of cases are bilateral, they often prophylactically pin the contralateral side.

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