Conventional treatment of mild slipped capital femoral epiphysis consists of fixation in situ with wires or screws. Recent contributions to the literature suggest that even a mild slip may lead to early damage of the acetabular labrum and adjacent cartilage by abutment of a prominent femoral metaphysis. It has been suggested that the appropriate treatment in mild slipped capital femoral epiphysis should not only prevent further slipping of the epiphysis, but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. Between October 1984 and December 1995 we treated 16 patients for unilateral mild slipped capital femoral epiphysis by fixation in situ with Kirschner wires. In this study we have reviewed these patients for clinical and radiological evidence of femoroacetabular impingement. There was little clinical indication of impingement but radiological evaluation assessing the femoral head-neck ratio and measuring the Nötzli alpha angle on the anteroposterior and cross-table radiographs showed significant alterations in the proximal femur. None of the affected hips had a normal head-neck ratio and the mean alpha angle was 86 degrees (55 degrees to 99 degrees ) and 55 degrees (40 degrees to 94 degrees ) on the anteroposterior and lateral cross-table radiographs, respectively. While our clinical data favours conventional treatment, our radiological findings are in support of restoring the anatomy of the proximal femur to avoid or delay the development of femoroacetabular impingement following mild slipped capital femoral epiphysis.
This study shows that neither monosegmental instrumented fusion nor monosegmental posterior dynamic stabilization with Dynesys alter the ROM of the cranial and caudal adjacent levels. Consequently, monosegmental posterior dynamic stabilization with Dynesys has no effect with regard to adjacent segment mobility compared with monosegmental fusion.
Study Design. Radiologic evaluation of lumbar range of motion (ROM) with dynamic radiograph.Objectives. To calculate 95% confidence intervals (CIs) for the measurement error accompanying different methods, different observers, and different levels of training when measuring sagittal plane segmental ROM in lumbar spine. In addition, to compare the 95% CI with frequently common statistical methods of reliability analysis.Summary of Background Data. Dynamic radiographs are commonly used for ROM calculation of the lumbar spine. Yet, the reliability of different measurement methods still remains unclear.Methods. In 24 patients, levels L4 -L5 and L5-S1 were measured with the Cobb and superimposition methods on flexion-extension radiographs. There were 2 experienced and 1 inexperienced observer that performed the measurements. The 95% CIs were compared with the corresponding Pearson correlation coefficient and P value (t test).Results. The 95% CI of the superimposition method was Ϯ4.0°for the experienced and Ϯ4.7°for the inexperienced observer. The corresponding values for the Cobb method was Ϯ4.2°for the experienced and Ϯ6.8°for the inexperienced observer. The 95% CI for the measurement error became even worse when different methods or observers were compared, whereas a method constancy revealed superior reliability than observer constancy in experienced observers.Conclusions. For lumbar ROM measurement with dynamic radiograph, the superimposition method seems to be more reliable than the Cobb method. Study protocols dealing with ROM measurement have to calculate the 95% CI of the measurement method used because clinically valid conclusions can only be drawn with respect to these intervals.
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