Atypical Slipped Capital Femoral Epiphysis after Radiotherapy and Chemotherapy

Liu, Shih‐Chia; Tsai, Chia-Che; Huang, Chun‐Hsiung

doi:10.1097/01.blo.0000136655.51838.84

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…Previous literature reviews were excluded. Specific musculoskeletal effects, including low BMD (5), osteonecrosis (6), slipped capital femoral epiphyses (7), limb salvage and amputation related late effects (10), oncogenic rickets (8), and hormone-related growth complications after cranial radiation (9) were excluded because comprehensive reviews have been published. Primary outcomes were defined as the occurrence of musculoskeletal complications at least 2 years after completion of cancer therapy.…”

Section: Methodsmentioning

confidence: 99%

“…Late musculoskeletal effects such as low bone mineral density (BMD) (5), osteonecrosis (6), slipped capital femoral epiphyses (7), oncogenic rickets (8), hormone-related growth disturbances (9), and limb salvage and amputation-related outcomes (10), have been comprehensively reviewed. However, the current state of knowledge about other, equally important, musculoskeletal late effects has not been systematically evaluated.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review of Selected Musculoskeletal Late Effects in Survivors of Childhood Cancer

Gawade¹,

Hudson²,

Kaste³

et al. 2015

CPR

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Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications. This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal late effects. We searched PubMed and Web of Science for English language articles published between January 1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects, including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormone-related growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional 54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment, and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced by host and treatment characteristics.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Selected Musculoskeletal Late Effects in Survivors of Childhood Cancer

Gawade¹,

Hudson²,

Kaste³

et al. 2015

CPR

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“…3 Atypical SCFEs are those that occur in the presence of an endocrine disorder, 4 renal failure osteodystrophy, 5 or radiation therapy. 6 The risk factors for further progression include atypical SCFE presentation, obesity, male gender, and early age of onset. 7 In cases of subsequent contralateral progression, the second slip was diagnosed within 18 months of the first slip 82% of the time.…”

Section: Introductionmentioning

confidence: 99%

Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation

Yang

Chan

Cheng

et al. 2020

J Orthop Surg (Hong Kong)

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Background: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater than 12–14.5° has been proposed by various authors as a treatment threshold to predict for contralateral hip progression and prophylactic pinning. Methods: A retrospective review of a 10-year series of patients with the diagnosis of SCFE and follow-up of 18 months was conducted. Patients were divided into two groups, those with Isolated Unilateral Slips and those who subsequently underwent Subsequent Contralateral Progression. PSA measurements were performed by two clinicians and assessed for inter-observer reliability. Data collected included age, sex, ethnicity, Loder class, endocrinopathy, renal impairment, radiation exposure, and PSA. Results: There were no significant differences between the distribution of gender, site of slip, age of onset, Loder class, and presence of medical comorbidities between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups ( p > 0.05). The mean PSA value was not significantly higher in the Subsequent Contralateral Progression group (17.9 ± 4.32 (10.5–23.5)) compared to the Isolated Unilateral Slip group (15.8 ± 5.31 (6–26)) ( p = 0.32). The receiver operator coefficient-derived ideal treatment threshold of 16.5° gave a sensitivity of 0.71, specificity of 0.64, and number needed to treat of 3. Conclusion: PSA differences between the Subsequent Contralateral Progression and Isolated Unilateral Slip groups were not statistically significant in this series. All proposed treatment thresholds had poor specificity. Prophylactic pinning should not be based on isolated PSA values. Level of evidence: III.

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“…Most SCFEs are varus (medial and posterior epiphyseal displacement relative to the metaphysic) but can occasionally be valgus (lateral and superior epiphyseal displacement) [ 1 – 4 ]. The vast majority are “idiopathic”; atypical SCFEs are those that occur due to an endocrine disorder [ 5 – 7 ], renal failure osteodystrophy [ 8 ], or radiation therapy [ 7 , 9 , 10 ]. The literature regarding the epidemiology and demographics of SCFE first requires a general knowledge of the disorder.…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

2011

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The etiology of slipped capital femoral epiphysis (SCFE) is unknown with many insights coming from epidemiologic/demographic information. A systematic medical literature review regarding SCFE was performed. The incidence is 0.33/100,000 to 24.58/100,000 children 8 to 15 years of age. The relative racial frequency, relative to Caucasians at 1.0, is 5.6 for Polynesians, 3.9 for Blacks, and 2.5 for Hispanics. The average age is 12.0 years for boys and 11.2 years for girls. The physiologic age when SCFE occurs is less variable than the chronologic age. The average symptom duration is 4 to 5 months. Most children are obese: >50% are >95th percentile weight for age with average BMI is 25–30 kg/m2. The onset of SCFE is in the summer when north of 40°N. Bilaterality ranges from 18 to 50%. In children with bilateral involvement, 50–60% present with simultaneous SCFEs and those who present with a unilateral SCFE and subsequently develop a contralateral SCFE do so within 18 months. The age at presentation is younger for those who present with a unilateral SCFE and later develop a contralateral SCFE. The age-weight, age-height, and height test are useful to differentiate between an idiopathic and atypical SCFE.

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Atypical Slipped Capital Femoral Epiphysis after Radiotherapy and Chemotherapy

Cited by 16 publications

References 16 publications

A Systematic Review of Selected Musculoskeletal Late Effects in Survivors of Childhood Cancer

A Systematic Review of Selected Musculoskeletal Late Effects in Survivors of Childhood Cancer

Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

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