However, the dose required for the examination means that it should not be used unless absolutely necessary. CTĬT is a sensitive and accurate method of measuring the degree of upper femoral epiphyseal tilt and detecting the disease in its early stage. Multi-plane reconstruction allows assessment of the relationship of the femoral head to the metaphysis in three planes. In some cases, malalignment of the femoral epiphysis and metaphysis may be seen. However, it should not be used as a replacement for a pelvic radiograph. Findings are nonspecific and may include hip joint effusion. Ultrasound may be performed in the assessment of hip pain. The metaphyseal blanch sign, a sign seen on AP views, involves increases in the density of the proximal metaphysis. It represents the superposition of the femoral neck and the posteriorly displaced capital epiphysis.Īlignment of the epiphysis with respect to the femoral metaphysis can be used to grade the degree of slippage: see SUFE grading. The metaphysis is displaced laterally and therefore may not overlap the posterior lip of the acetabulum as it should normally (loss of triangular sign of Capener) 5. On the AP, a line drawn up the lateral edge of the femoral neck ( line of Klein) fails to intersect the epiphysis during the acute phase ( Trethowan sign). Because the epiphysis moves posteriorly, it appears smaller because of projectional factors. It is therefore is more easily seen on the frog-leg lateral view rather than the AP hip view. The slip that occurs is posterior and, to a lesser extent, medial. In a chronic slip, the physis becomes sclerotic and the metaphysis widens ( coxa magna). This is followed by the acute slip, which is posteromedial. In the pre-slip phase, there is a widening of the growth plate with irregularity and blurring of the physeal edges and demineralization of the metaphysis. The radiographic series used to investigate varies depending on institution:ĪP and frog-leg: two view assessment is common, often done bilateral as high number of these injuries are bilateral (as well as the added benefit of comparing to a normal side) 11 However, there should always be one radiograph without lead protection so that the entire pelvis is visualized. Gonad protection is usually used in pelvic x-rays of children. In all situations, especially when imaging children, the fewest number of radiographs, with the smallest exposed area is performed. As the physis becomes more oblique, shear forces across the growth plate increase and result in an increased risk of fracture and resultant slippage. Also, the axis of the physis alters during growth and moves from being horizontal to being oblique. Slipped upper femoral epiphysis is a type I Salter-Harris growth plate injury due to repeated trauma on a background of mechanical and probably hormonal predisposing factors.ĭuring growth, there is a widening of the physeal plate which is particularly pronounced during a growth spurt. Vague groin and thigh pain for more than 3 weeks, may progress to a limpĪcute-on-chronic: the prodromal symptoms have been present for more than 3 weeks, but there is a sudden worsening of the symptoms, including becoming unable to bear weight when previously able to Regarding the onset of symptoms, SCFE is usually classified into three groups 10:Īcute: severe hip pain and inability to bear weight, usually after a minor trauma, with prodromal symptoms such as vague groin or thigh pain for up to 3 weeks before the acute presentationĬhronic: represents the most common presentation. It's important to understand that this refers to clinical presentation, but even the patient initially able to bear weight is at risk of evolving to an acute displacement if bed rest is not established 10. A patient with a stable slip can tolerate weight bearing. Patients with an unstable slip present similarly to those with an acute femoral fracture and are unable to bear weight on the affected limb. Patients may present in different ways depending on the epiphysis stability and the duration of the onset of the symptoms. Risk factorsĬonditions that may predispose to SUFE include: Slipped upper femoral epiphysis is more common in boys than girls and more common in African Caribbean patients than Caucasian patients. The age of presentation is somewhat dependent on gender with boys presenting later (10-17 years) than girls (8-15 years) 2.
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