Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

Leblanc, Elisabeth; Bellemore, Jeremy M.; Cheng, Tegan L.; Little, David; Birke, Oliver

doi:10.1302/1863-2548-11-170012

Cited by 24 publications

(20 citation statements)

References 22 publications

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“…Finite element analysis has been previously used in several studies to investigate the influence of growth plate characteristics and shear loads on development and progression of SCFE . Our findings are in line with those by Fishkin et al who demonstrated with a finite element study that the peak stress distribution is concentrated in the posterior part of the proximal femoral physis.…”

Section: Discussionsupporting

confidence: 90%

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Kiapour

Maranho

et al. 2019

Journal Orthopaedic Research

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Epiphyseal tubercle and peripheral cupping can influence the development of slipped capital femoral epiphysis (SCFE) and Cam morphology. During normal skeletal growth, epiphyseal tubercle shrinks while the peripheral cupping grows. We hypothesized that epiphyseal tubercle act as the primary stabilizer of the head-neck junction at early stages and this role is gradually transferred to epiphyseal cupping as the tubercle shrinks and cupping grows. From a cohort of 80 boys and girls (8-15 years old) with normal hips, CT scans of 5 subjects corresponding to minimum, 25th percentile, median, 75th percentile and maximum relative tubercle and cupping height were used to develop 3D finite element models. In vivo measured hip loads were used to study load sharing between the tubercle and peripheral cupping under combined and uniaxial loads exerted on femoral head during a range of daily activities. Lower epiphyseal tubercle height, larger epiphyseal cupping height and bigger differences in tubercle and cupping heights were strongly associated with increased epiphyseal cupping to epiphyseal tubercle stress ratios (R 2 > 0.7). We found lower peripheral cupping stresses relative to the tubercle (cupping to tubercle stress ratio <1) in hips with larger tubercle and smaller cupping. The relative decreases in tubercle size along with increased in peripheral cupping in our models gradually shifted the load distribution to higher stresses in the periphery compared to the epiphyseal tubercle area (cupping to tubercle stress ratio >1). Both tubercle and

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Section: Discussionsupporting

confidence: 90%

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Kiapour

Maranho

et al. 2019

Journal Orthopaedic Research

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“…Also, it has been suggested that increasing the height of the growth plate unlocks the interdigitating secondary mammillary processes (Speer & Braun, 1985) to reduce resistance to shear. Radiologists have reported widening of the growth plate accompanying slips, which may be subtle or as much as a five‐fold increase in thickness (Khaladkar et al, 2015; Leblanc, Bellemore, et al, 2017; Tresoldi, Modesti, et al, 2017), although it is unclear if this widening is a contributing factor to the slip or a consequence thereof. The thickness or height of the growth plate varies with age, rate of growth and endocrine function.…”

Section: Discussionmentioning

confidence: 99%

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

Perrone

Williams

2021

The Anatomical Record

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The capital femoral physis is a growth plate located between the head of the femur and femoral neck, which forms a temporary joint where growth plate cartilage is converted to bone by endochondral ossification. The bone‐cartilage‐bone interface develops a unique radial pattern of interdigitating mammillary processes that interlock the femoral head with the metaphysis, increasing biomechanical stability. The arrangement of these mammillary processes may not be a random occurrence and likely serves to provide mechanical mechanisms to enhance biomechanical stability. In this study, we provide a qualitative and quantitative analysis of porcine femoral head mammillary processes and focus on the analysis of six key points of development: the epiphyseal tubercle, epiphyseal cupping, growth plate slope angles, expansion of the epiphyseal subchondral bone plate, epiphyseal elongation, and the emergence of smaller, radially arranged mammillary processes. We introduce a metric of surface roughness analysis to quantify mammillary processes and apply it to analyze the development of the observed radial pattern of peripheral mammillary processes from birth to adolescence. We hypothesized that these processes develop to form a radial pattern with some degree of periodicity beginning relatively early in development of the joint and increase in prominence with age and weight of the animal. These findings may have important implications in the early diagnosis and treatment of the hip disorder slipped capital femoral epiphysis (SCFE). Underdevelopment of femoral head mammillary processes may reduce joint stability and could be a risk factor in SCFE.

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“…The premature physeal closure leads to modifications of the epiphyseal–metaphyseal complex which itself becomes a cause of impingement [ 30 , 32 ]. To avoid this complication, it is necessary to use a type of in situ fixation device which allows continued physeal growth [ 13 , 18 – 21 ]. Immediate arthroscopic osteoplasty as Leunig et al (2010) [ 11 ] proposed might not be necessary if the initial treatment is done using such a device.…”

Section: Discussionmentioning

confidence: 99%

“…As described by Menelaus (1991) [ 12 ], the femoral neck grows at an estimated rate of 4.0 mm/year. In younger patients, premature closure of the physis risks development of a short femoral neck, producing a short lever arm and a high-riding trochanter with progressive deformity of the epiphyseal–metaphyseal complex of the proximal femur, leading to premature osteoarthritis [ 13 , 14 ]. A standard screw fixation associated with an osteochondroplasty may then cause a premature closure of the physis and consequent deformity of the head-neck junction associated with an overgrowth of the great trochanter.…”

Section: Introductionmentioning

confidence: 99%

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

et al. 2017

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BackgroundThe appropriate treatment in mild slipped capital femoral epiphysis (SCFE) should not only prevent further slipping of the epiphysis but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. The aim of this study was to quantify length of the remodeling phase mediated by growth of the femoral neck, after treatment of SCFE with a screw designed to prevent premature closure of the physis and provide stability.MethodsBetween 2001 and 2011, 38 patients with unilateral mild SCFE were treated by fixation in situ using a modified screw which does not cause premature physeal arrest. Twenty-four patients were investigated for clinical and radiological evidence of femoroacetabular impingement immediately after surgery, at 6- and 12-month follow-ups. Statistical analysis was performed comparing measurements of neck length and the α angle of the affected and contralateral side.ResultsMean α angle immediately after pinning was 56.2 ± 10.6° on the anteroposterior view and 91.4 ± 8.2° on the lateral view. These measurements significantly improved at 6 months post-op to 48.9 ± 5.4° on the anteroposterior view and 51.2 ± 6.5° on the lateral view (p < 0.0001). At 12 months from surgery, AP view α angle was 43.0 ± 2.8° (p < 0.0001) and lateral view was 44.2 ± 4.1° (p < 0.0001). We observed a similar growth rate and speed of the femoral neck of both the affected and unaffected sides during the first year of treatment. The clinical results in all patients were rated as excellent.ConclusionOur data supports the use of a surgical technique that allows residual growth of the femoral neck following mild SCFE and permits restoration of the anatomy of the proximal femur while avoiding development of femoroacetabular impingement following mild SCFE.

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Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

Cited by 24 publications

References 22 publications

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

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