Evidence-Based Treatment for Slipped Upper Femoral Epiphysis
Slipped upper femoral epiphysis (SUFE), though not common, is an important paediatric disorder. It has a reported incidence of 1–10 per 100,000. Some aspects of management of SUFE are controversial and evolving with advancing surgical skills and expertise
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Sattar Alshryda, Kai Tsang, and Gavin De Kiewiet
Abstract
Slipped upper femoral epiphysis (SUFE), though not common, is an important paediatric disorder. It has a reported incidence of 1–10 per 100,000. Some aspects of management of SUFE are controversial and evolving with advancing surgical skills and expertise. The infrequency of cases, the various classifications in use, the various surgical treatments, and lack of robust evidence for outcomes, has resulted in the lack of clear, evidence-based recommendations for treatment. The following review examined the current evidence for treating SUFE and concluded that pinning in situ is the best treatment for mild and moderate stable slip (grade B). Surgical dislocation may give better results than pinning in situ for severe stable slip (grade C). Urgent gentle reduction, capsulotomy and fixation is the best current treatment for unstable slip (grade C). Routine prophylactic pinning of the contralateral asymptomatic side is not recommended (grade C) Keywords
SUFE • SCFE • Slipped • Stable slip • Unstable slip • Loders classification • AVN • Osteonecrosis • FHO • Slipped upper femoral epiphysis
Background Slipped upper femoral epiphysis (SUFE) is one of the most important paediatric and adolescent hip disorder. Incidence is 1–10:100,000. Patients usually presented with painful hip and or knee with affected leg is short and externally rotated (Fig. 6.1). The plain x-ray is usually diagnostic (Fig. 6.2). The cause is poorly understood, it is believed that increased shear forces and/or weak growth plate (the physis) in adolescence predispose to slips.
S. Alshryda (*) Consultant Trauma and Paediatric Orthopaedic Surgeon, Royal Manchester Children’s Hospital, Manchester, UK e-mail: [email protected] K. Tsang Royal Stoke Hospital, Stoke-on-Trent, UK e-mail: [email protected] G. De Kiewiet Sunderland Royal Infirmary, Kayll Rd, Sunderland, UK e-mail: [email protected]
Although rare, endocrine disorders must be considered in every patient with SUFE. Loder [1] identified two types of SUFE; idiopathic type and atypical type where there is an underlying endocrine disorders or other aetiology. He studied the demographics of 433 patients with 612 SUFEs (285 idiopathic, 148 atypical) and found that weight and age were predictors for atypical SUFE and he recommended the ageweight test: the test was defined as negative when age younger than 16 years and weight ≥50th percentile and positive when beyond these boundaries. The probability of a child with a negative test result having an idiopathic SUFE was 93 %, and the probability of a child with a positive test result having an atypical SCFE was 52 %. Slipped upper femoral epiphysis was traditionally classified as (1) pre-slip: patient has symptoms with no anatomical displacement of the femoral head, (2) acute: there is an abrupt displacement through the proximal physis with symptoms and signs developing over a short period of time ( 72 h
16 < 24 h 3 < 48 h 3 < 72 5 > 120 h 49 < 24 h 15 > 224 h
Trac
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