Slipped epiphysis (SUFE, SCFE) is a relatively uncommon childhood condition where the ball of the femur in the hip joint slides off the back of the femur to a small or large extent. The problem occurs in the growth plate of the hip (physis) the head part is the epi-physis. It causes pain in the leg – it can be over the knee, but might be in the thigh or groin. If the slip is severe, the leg points outwards. If acute, the pain can be severe and the child unable to walk. If more subtle and subacute, the limp might be the most obvious feature.
If the initial concern is knee, and health practitioner finds nothing wrong with the knee, then XR of both hips are required to be sure the cause of the problem isn’t a slipped epiphysis.
This case demonstrates on XR the left hip in a “frog leg lateral” (right side your screen) demonstrated the subtle signs of a slipped epiphysis.
This adolescent had both hips pinned. There is discrepancy of opinion between surgeons whether both sides should be pinned initially, or whether to only operate on the second hip if symptomatic. Advances that have been made are using a different entry point to ensure the screw is aimed for the centre of the head, the operation might be done through a 1cm incision, and where possible stainless screws are easier to subsequently remove. The screw need not be removed as a rule.
Our practice has done the majority of cases in Ballarat and district over the last decade – either at St John’s or through Ballarat Base Hospital. Some severe cases are transferred to Royal Children’s Hospital for consideration of correcting the deformity rather than simply fixing it in position.
Mr David Mitchell