Patients may develop pain suddenly (acutely) or over a period of several weeks (chronic) or even months. Acute slips can occur without warning but may also follow traumatic incidents such as falls or sporting injuries. Chronic slips are more insidious and may be confusing since patients often describe an aching pain in the thigh or knee rather than in the hip.
As the slip becomes more severe patients develop a limp. The leg appears shorter and the foot turns out to the side (externally rotates). When examined patients have a painful restriction to internal rotation.
The degree of slip can be graded as mild, moderate or severe on the basis of plain X rays. The diagnosis is easy in severe slips but can be difficult in early cases. Often two views are required (antero-posterior and lateral). MRI or CT scans can occasionally be useful if plain X rays appear normal.
The prognosis is directly related to the severity of slip. If a SUFE is identified early before the head has moved very far the prognosis is good. Further progression can be prevented by pinning the hip (in situ pinning). More severe slips can also be managed in this way but patients will have a persistent limp. Alternatively the deformity can be corrected by dividing the femur bone (osteotomy). Two surgical procedures are utilised (Modified Imhauser, Modified Dunn). Mr Bache is one of very few surgeons who have significant experience in these techniques and has presented his results Nationally. He is the lead surgeon for the management of severe SUFE at Birmingham Children’s and The Royal orthopaedic Hospital.