Delay in Diagnosis of Slipped Upper Femoral Epiphysis

Abstract

Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10–16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight. The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2–504); in the 7 referred from accident and emergency departments it was 95 days (1–482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views. Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

“…Slip severity and symptom duration is greater in children presenting with knee pain compared to other symptoms [88–91]. In a study of 45 children [89], 15 presented solely with knee pain having an average symptom duration of 8.3 months; 74% of the SCFEs were severe.…”

The child with joint pain in primary care

“…Delay in stabilisation of the SUFE is associated with increasing slip severity and adverse outcome such as avascular necrosis of the femoral head [97]; thus, an urgent referral to an orthopaedic surgeon or emergency department should be made in cases of suspected SUFE. In one study investigating delays in diagnosis, there was a notable delay in the time from onset of symptoms to definitive diagnosis for those patients who presented to primary care rather than to an emergency department, although the reasons for this were unclear and may be partially attributed to different severity of symptoms between the two groups [98]. The outcome and prognosis of SUFE depends on early detection and stabilisation of the hip; thus, primary care physicians should remain alert to the possibility of SUFE in adolescent patients with hip, thigh or knee pain.…”

Hip fractures in the Portuguese archaeological record

“…The alterations described are consistent with a subcapital neck fracture (an intracapsular fracture), with a varus rotation of the head. Alternatively, this case might represent a slipped capital femoral epiphysis (Brenkel et al, 1986;Ankarath et al, 2002). Slipped capital epiphysis is a Salter-Harris type 1 fracture through the proximal femoral physis and usually occurs in adolescents at about the growth spurt.…”