A 30-Year Experience with Bone Graft Epiphysiodesis in the Treatment of Slipped Capital Femoral Epiphysis

Weiner, Dennis S.; Weiner, Scott D.; Melby, Arne; Hoyt, Walter A.

doi:10.1097/01241398-198403000-00001

Cited by 45 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] Although some authors still advocate bone peg epiphyseodesis, [12][13][14][15][16][17][18] others who previously advocated this technique have now abandoned it in favor of cannulated screw fixation. 19,20 The treatment of unstable SCFE is much more controversial, with little consensus on the best treatment method.…”

mentioning

confidence: 99%

Urgent Reduction, Fixation, and Arthrotomy for Unstable Slipped Capital Femoral Epiphysis

Chen¹,

Schoenecker²,

Dobbs³

et al. 2009

Journal of Pediatric Orthopaedics

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confidence: 99%

Urgent Reduction, Fixation, and Arthrotomy for Unstable Slipped Capital Femoral Epiphysis

Chen¹,

Schoenecker²,

Dobbs³

et al. 2009

Journal of Pediatric Orthopaedics

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“…Bone graft epiphysiodesis, primarily as an open procedure, has previously been used for treating SCFE [1,32,43]. The open procedure requires an intracapsular approach and grafting through the femoral neck into the center of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

“…The objectives of this procedure are to decompress the epiphysis and allow for rapid revascularization of the CFE before the development of a subchondral fracture, the hallmark of progressive collapse and deformity. Bone graft epiphysiodesis has been used as a primary treatment for SCFE, but to our knowledge, there is no description of its use as a treatment for AVN [1,43]. When used in SCFE, including the unstable form, the incidence of AVN is reportedly less than 8% [1,43], indicating a biologic effect.…”

Section: Introductionmentioning

confidence: 99%

“…Bone graft epiphysiodesis has been used as a primary treatment for SCFE, but to our knowledge, there is no description of its use as a treatment for AVN [1,43]. When used in SCFE, including the unstable form, the incidence of AVN is reportedly less than 8% [1,43], indicating a biologic effect. However, it is unclear whether CBGE will prevent progression in patients with evidence of early AVN.…”

Section: Introductionmentioning

confidence: 99%

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Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

Thompson

Lea

Chin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression. Questions/purposes We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach. Methods We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression. Results Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9

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“…Patients were also grouped into acute (symptoms 53 weeks), chronic (symptoms 53 weeks) and acute-on-chronic 1 . The degree of slip was measured by calculating the head-shaft angle on a lateral radiograph and was graded as mild (5308), moderate (30-508) or severe (4508) 3 (Figure 1). All measurements were made by the senior author to limit interobserver variation.…”

Section: Methodsmentioning

confidence: 99%

Delay in Diagnosis of Slipped Upper Femoral Epiphysis

Ankarath

Giannoudis

et al. 2002

J R Soc Med

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Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10–16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight. The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2–504); in the 7 referred from accident and emergency departments it was 95 days (1–482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views. Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.

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A 30-Year Experience with Bone Graft Epiphysiodesis in the Treatment of Slipped Capital Femoral Epiphysis

Cited by 45 publications

References 0 publications

Urgent Reduction, Fixation, and Arthrotomy for Unstable Slipped Capital Femoral Epiphysis

Urgent Reduction, Fixation, and Arthrotomy for Unstable Slipped Capital Femoral Epiphysis

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

Delay in Diagnosis of Slipped Upper Femoral Epiphysis

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