Pre-slip of the Capital Femoral Epiphysis, a Diagnosis Not to Miss!

Purpose or Learning Objective: To diagnose the early stages of a slipped capital femoral epiphysis (SCFE) (pre-slip) and to assess the pre-slip stage at the contralateral side of a known SCFE.

Methods or Background: An SCFE is a common pediatric disorder, with magnetic resonance imaging (MRI) the gold standard for early diagnosis. It is defined as a posteromedial tilt of the femoral head associated with widening and edema of the growth plate. In the absence of femoral head displacement, the diagnosis of pre-slip should be suggested. This initial finding (edema with widening of the physis) can be overlooked and misdiagnosed at the early stage of the disease but also on the contralateral hip of a confirmed SCFE. We review a case report of a young tennis player with a pre-slip SCFE.

Results or Findings: We report the case of an 11-year-old semiprofessional tennis player who was referred for MRI of the left hip after an acute onset of pain at the left inguinal area during a tournament game that forced him to withdraw from play. Initial imaging conducted at the tournament site described a transient hip synovitis on ultrasonography without any abnormality on radiographs. The patient was treated conservatively for 2 weeks and referred for MRI after increased pain and limited range of motion of the same hip. MRI findings suggested a pre-slip capital femoral epiphysis, and the patient was referred to pediatric surgery for management.

Conclusion: Pre-slip of the femoral capital epiphysis is an early stage of the disease that can be diagnosed on MRI to initiate early adequate treatment and prevent the slip. It should be assessed on the contralateral hip on all MRIs for SCFE because the pathology is bilateral in 20 to 80% of cases.

Publication History

Article published online:
22 May 2024