Anterior physeal separation: A sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis

Ballard, Jeanne L.; Cosgrove, A.P.

doi:10.1302/0301-620x.84b8.12904

Cited by 28 publications

(24 citation statements)

References 13 publications

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“…A recent article [16] on 176 hips pinned in situ reported 12% reoperations, 33% pain, and a Marx activity score [24] of five of 16 after 16 years (range, 2-43 years). Risk factors for epiphyseal necrosis, with incidence ranging from 4.7% to 58% [3,13,23,34] in clinically unstable slips, are still unclear [30] although the prevailing opinion is vascular injury at the initial displacement [1,15,22,27,29]. Further risk factors are timing of surgery, intracapsular pressure [25,30,37], applied reduction force, amount of reduction [34], but also younger patient age [30].…”

Section: Discussionmentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Ziebarth

Leunig

Slongo

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation. Questions/purposes We (1) determined the influence of chronicity of prodromal symptoms and severity of SCFE deformity on severity of cartilage damage. (2) In surgically confirmed disconnected epiphyses, we determined the influence of injury and time to surgery on epiphyseal perfusion; and (3) the frequency of new bone at the posterior neck potentially reducing perfusion during epimetaphyseal reduction. Methods We reviewed 116 patients with 119 SCFE and available records treated between 1996 and 2011. Acetabular cartilage damage was graded as +/++/+++ in 109 of the 119 hips. Epiphyseal perfusion was determined with laser-Doppler flowmetry at capsulotomy and after reduction. Information about bone at the posterior neck was retrieved from operative reports.

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Section: Discussionmentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Ziebarth

Leunig

Slongo

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Although both of these classification systems were used together in the reports on AVN after SCFE from 1996, most reports used only Loder's classification system after 2000. In these reports, the rate of AVN after SCFE according to the classification ranged from 12.2 to 23.0% [2][3][4][5] for acute slip and from 0 to 58% for unstable slip [1,[6][7][8][9][10][11][12][13]. Most recent reports have discussed AVN in only unstable SCFE.…”

Section: Introductionmentioning

confidence: 99%

“…Most recent reports have discussed AVN in only unstable SCFE. However, Ballard and Cosgrove [6] described that there were examples of AVN development in stable slip using Loder's classification. Under these circumstances, it is necessary to clarify the risk factor related to AVN after SCFE using not only Loder's classification system but also the classification based on the duration of condition.…”

Section: Introductionmentioning

confidence: 99%

Closed reduction of slipped capital femoral epiphysis

Kitano

Nakagawa

Wada

et al. 2015

Journal of Pediatric Orthopaedics B

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How should we treat acute/unstable slipped capital femoral epiphysis (SCFE) without the development of avascular necrosis (AVN)? To answer this question, we investigated the risk factors of AVN development after SCFE. Seventy-six hips of 64 patients were classified using two kinds of classification systems, Loder's classification based on instability and the conventional classification based on the duration of symptom, because both classifications are related to AVN development. Of 21 unstable SCFEs, seven hips developed AVN. Of 35 hips defined as acute or acute on chronic, nine hips developed AVN. Two stable SCFEs of Loder's classification developed AVN, one was acute and the other was acute on chronic. No hips of chronic SCFE developed AVN. The factor that had influenced AVN development was only closed reduction, whether purposefully or inadvertently, in an acute or unstable SCFE. On the basis of the findings of this study, one should not embark on any modality of closed reduction for an unstable or acute form of SCFE, as there is a high risk for occurrence of AVN. For the same reason, a traction table should not be used for SCFE fixation, so as to avoid an inadvertent reduction or force that can lead to AVN.

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“…Most SCFE deformities occur with gradual displacement of the femoral head from the metaphysis and with risk of avascular necrosis (AVN) up to 4.6% [28]. However, abrupt and complete disconnection of the epiphysis from the metaphysis -a so-called unstable slip -is not uncommon and has been associated with incidences of AVN ranging from 4.7% to 58% [5,13,24,36,37,44,47]. However, the exact cause for AVN developing in patients with SCFE remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) -so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations. Questions/purposes We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/ unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? Methods We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability. Results Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively. Conclusion Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE.

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Anterior physeal separation: A sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis

Cited by 28 publications

References 13 publications

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Closed reduction of slipped capital femoral epiphysis

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

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