Presentation
Back pain. Scoliosis.
Patient Data
There is mild dorsal asymmetry of the lumbar spine, but no evidence of scoliosis.
Selected 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 missed. 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.
The 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
The left hip has been pinned. In this case, with a full-thread cannulated screw.
Case Discussion
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 edema, 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.
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