SLIPPED UPPER FEMORAL EPIPHYSIS IN THE VERY YOUNG – AN EMERGING PROBLEM?

Introduction: Slipped Upper Femoral Epiphysis (SUFE) is very rare in children less than 10 years of age but may be more common with increasing obesity in children. There are concerns with the presentation of SUFE in this age group regarding bilateral slips and prophylactic pinning, fixation with multiple pins to preserve growth, and complications. Methods: We identified 12 cases of SUFE in 8 patients who presented aged less than 10 years to our institution between 1997 and 2004. Case note and radiographic review were carried out. Results: There were 5 boys and 3 girls in this group, with an average follow-up of 48 months (6 – 90 months). Bilateral SUFE was present in 4 patients (50%). Only 3 slips were unstable. One child was found to be hypothyroid and another had oculocutaneous albinism. The remaining children had normal genetic and endocrine profiles. Six children were above the 90th centile for weight. The severity of slip was mild in 9 hips and moderate in 3 hips. Multiple threaded pins were used in 10 hips and a cannulated screw in 2 hips. Complications include revision surgery due to loss of fixation in 3 hips and a superficial wound infection. There were no cases of avascular necrosis and chondrolysis. Discussion: Gross obesity is the commonest predisposing factor. The high incidence of bilateral involvement is an indication for prophylactic pinning. Multiple threaded pins may need to be revised if the fixation is lost as the child grows. These should be left proud of the lateral femoral cortex to facilitate removal, although at the risk of producing a windscreen wiper effect.