Slipped upper femoral epiphysis (pre-slip)
Updates to Case Attributes
Slipped upper femoral epiphysis is a relatively common cause of hip pain in skeletally immature patients. The diagnosis is often made on plain films and isn't controversial.
If patients present with back or hip pain and the cause is not clear, further investigation (usually in the form of MRI) is required. In this case, the MRI demonstrated metaphyseal and physeal oedema, CT confirmed evidence of physeal abnormality secondary to micro-movement and the orthopod pre-emtively operated to fix the physis.
Pre-slip in SUFE is defined as hip pain without radiographic abnormality subsequently found on other imaging 1. Fixing the pre-slip SUFE renders a significantly reduced risk of AVN than if the patient went on to have a full slipped femoral epiphysis.
- +<p><a href="/articles/slipped-upper-femoral-epiphysis" title="Slipped upper femoral epiphysis">Slipped upper femoral epiphysis</a> is a relatively common cause of hip pain in skeletally immature patients. The diagnosis is often made on plain films and isn't controversial.</p><p>If patients present with back or hip pain and the cause is not clear, further investigation (usually in the form of MRI) is required. In this case, the MRI demonstrated metaphyseal and physeal oedema, CT confirmed evidence of physeal abnormality secondary to micro-movement and the orthopod pre-emtively operated to fix the physis.</p><p>Pre-slip in SUFE is defined as hip pain without radiographic abnormality subsequently found on other imaging <sup>1</sup>. Fixing the pre-slip SUFE renders a significantly reduced risk of AVN than if the patient went on to have a full slipped femoral epiphysis.</p>
References changed:
- 1. Balch Samora J, Adler B, Druhan S et al. MRI in Idiopathic, Stable, Slipped Capital Femoral Epiphysis: Evaluation of Contralateral Pre-Slip. J Child Orthop. 2018;12(5):454-60. <a href="https://doi.org/10.1302/1863-2548.12.170204">doi:10.1302/1863-2548.12.170204</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30294369">Pubmed</a>
Updates to Study Attributes
There is mild dorsal asymmetry of the lumbar spine, but no evidence of scoliosis.
Image X-ray (Frontal) ( update )
Image X-ray (Frontal) ( update )
Image X-ray (Lateral) ( update )
Image X-ray (Lateral) ( update )
Image X-ray (Frontal) ( update )
Updates to Study Attributes
ToSelected images of the pelvis and left hip.
There is increased signal in the metaphysis of the left proximal femur. This is asymmetrical and abnormal.
In addition, there is linear STIR hyperintensity throughout the same physis. This is subtle and could easily be addedmissed. You need to go looking for it.
Asymmetric physeal and metaphyseal STIR hyperintensity should make you think about slipped upper femoral epiphysis in a skeletally immature patient. In this case, pre-slip.
Image MRI (PD) ( update )
Image MRI (T2 fat sat) ( update )
Image MRI (PD) ( update )
Image 11 MRI (T2 fat sat) ( create )
Image 11 MRI (T2 fat sat) ( create )
Updates to Study Attributes
To be addedThe CT confirms that there is abnormality of the left hip with gas within the physis, periphyseal cyst formation and associated sclerosis. All these features point to microtrauma and micromovement across the physis and suggest the pre-slip state of slipped upper femoral s
Image CT (bone window) ( update )
Image CT (bone window) ( update )
Image CT ( update )
Image 24 CT ( create )
Image 24 CT ( create )
Image 24 CT ( create )
Updates to Study Attributes
The left hip has been pinned. In this case, with a full-thread cannulated screw.
Image Fluoroscopy (Frontal) ( update )
Image Fluoroscopy (Oblique) ( update )
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