Skeletal Radiol (2002) 31:362–365
DOI 10.1007/s00256-002-0497-9
Received: 16 November 2001
Revised: 18 January 2002
Accepted: 12 February 2002
Published online: 23 March 2002
© ISS 2002
Abstract We describe the morpho-
logic and signal changes detected
about the proximal femoral growth
plate in two patients with hip pain
preceding the progression to slipped
capital femoral epiphysis using mag-
netic resonance imaging.
Keywords Slipped capital femoral
epiphysis · “Pre-slip” · Metaphyseal ·
Physeal · Growth plate · Magnetic
resonance imaging
CASE REPORT
A. Lalaji
H. Umans
R. Schneider
D. Mintz
M.S. Liebling
N. Haramati
MRI features of confirmed “pre-slip” capital
femoral epiphysis: a report of two cases
Introduction
We define pre-slip of the capital femoral epiphysis as hip
pain without radiographic evidence of slipped capital
femoral epiphysis (SCFE) in a child who, left untreated,
would progress to SCFE. Conventional radiographs may
reveal only subtle indistinctness of the proximal femoral
physis that might precede SCFE and indicate “pre-slip”
or impending SCFE. Although not recommended for
routine screening of SCFE, magnetic resonance imaging
(MRI) may be useful to evaluate radiographically occult
causes of hip pain, including: pre-slip, early avascular
necrosis, infectious or inflammatory synovitis, myoten-
dinous injury or neoplasm. We have previously reported
the MRI features of SCFE, including one case of pre-
sumed pre-slip [1]. The patient with presumed pre-slip
was prophylactically pinned; therefore, morphologic and
signal alterations about the proximal femoral physis, pre-
sumably related to pre-slip, remained of unproven clini-
cal relevance.
Without a sensitive diagnostic imaging test that could
detect abnormality prior to the development of SCFE,
pre-slip would remain a retrospective diagnosis of no
clinical or surgical consequence. We present two cases of
proven pre-slip which progressed to SCFE prior to pin-
ning. In both cases MRI demonstrated distortion of the
physis and/or peri-physeal bone marrow edema before
the development of radiographically detectable SCFE.
Case reports
Case 1
An 11-year-old female presented with limping and pain on move-
ment of her left hip which persisted for 2 weeks following a fall
onto her left side. Physical examination revealed painful restric-
A. Lalaji · H. Umans (
✉
) · M.S. Liebling
N. Haramati
Department of Radiology,
Albert Einstein College of Medicine and
Montefiore Medical Center,
111 East 210th Street, Bronx,
NY 10467, USA
e-mail: hilary.umans@verizon.net
Tel.: +1-718-9202916
Fax: +1-718-7987983
R. Schneider · D. Mintz
Department of Radiology,
The Hospital for Special Surgery,
525 East 71st Street, New York,
NY 10021, USA