Comparative Study of Pinning In Situ and Open Epiphysiodesis in 105 Patients with Slipped pital Femoral Epiphyses

Purpose Slipped capital femoral epiphysis (SCFE) represents the preliminary stage of osteoarthritis. Reliable tools for outcome evaluation should be developed to prevent persisting defects. The functional outcome of SCFEpatients after growth arrest is analysed by instrumented 3D-gait analysis (GA). The results are matched to the clinical examination findings. Methods A total of 39 SCFE patients after growth arrest (18.8 years; BMI 26.5 kg/m²) with unilateral affection were included. The clinical results were classified according to Harris hip and clinical Heyman Herndon scores. 3D-GAparameters were evaluated and compared to the sound side and a group of 40 healthy adults (28.0 years; 21.9 kg/m²). The subgroup analysis was performed according to clinical results. Results The clinical examination revealed very good results. GA could detect even small alterations. Some parameters indicated sustained functional impairments: Compared to the control group patients' walking speed (p=0.022), step frequency (p<0.001) and single support of the slip side (p<0.001) decreased, while step width (p= 0.014), double support (p=0.004) and stance time of sound side increased (p=0.001). For kinematics patients, the sagittal range of motion (ROM) of pelvis (p<0.001) and the external rotation of the ankle on both sides increased (p=0.011) and sagittal ROM of hip (p=0.002) and knee flexion of slip side (p<0.001) decreased. The sagittal ROM of the ankle on the slip side decreased compared to the sound side (p=0.003). Subgroup analysis revealed a positive correlation between clinically unsatisfying results and GA parameters. Conclusions Functional impairments in SCFE-patients can be found even after growth arrest. Alterations are explained partly by the disease and partly by patients' constitution. BMI-matched controls and long-term follow-up are needed.

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“…The clinical findings were evaluated according to the score of Heyman and Herndon [8] (Fig. 1) and Harris hip score (HHS) [9].…”

Section: Clinical Examinationsmentioning

confidence: 99%

The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

Westhoff

Ruhe

Weimann-Stahlschmidt

et al. 2011

International Orthopaedics (SICOT)

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“…Das Durchschnittsalter der Jungen betrug 13,1 (9 -16), das der Mädchen 11,[5][6][7][8][9][10][11][12][13][14] Jahre. Zum Zeitpunkt der Operation betrug der Body Mass Index (BMI) 24,2 (Min: 20; Max: 32) bei den mit Kirschner-Drähten und 21,9 (Min: 15; Max: 32) bei den mit Titanschrauben behandelten Kindern.…”

Section: Patientenunclassified

“…Es wurde eine ausführliche Verlaufsanamnese sowie ein klinischer Untersuchungsbefund erhoben. Hierbei wurde das Gangbild, das Bewegungsausmaß der Hüftgelenke inklusive des Drehmann-Zeichens, die Schmerzanamnese und der Aktivitätsgrad dokumentiert und anhand des von Heyman und Herndon [9] entwickelten und von Zahrawi et al [10] adaptierten Scores bewertet (l " Tab. 1).…”

Section: Nachuntersuchungunclassified

“…Gründe waren die Dislokation des Materials oder die unzureichende Fixierung der Epiphyse aufgrund des Restwachstums. Die Auswertung des nach Heyman und Herndon [9,10] adaptierten Scores (l " Tab. 1) ergab sowohl nach Versorgung mit Kirschner-Drähten mit durchschnittlich 3,13 ± 1,02, als auch nach Versorgung mit kanülierten Titanschrauben mit durchschnittlich 3,10 ± 1,01 Punkten ein exzellentes bis gutes Ergebnis.…”

Section: Statistische Auswertungunclassified

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Vergleich der Therapie der Epiphyseolysis capitis femoris mit Kirschner-Drähten und kanülierten Titanschrauben

et al. 2008

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“…Several treatment methods have been described, such as single screw fixation [5][6][7][8], multiple screws [9,10], pinning [11,12], open epiphyseodesis [13,14], osteotomies [15], manipulation [16,17] and even non-operative treatment [18].…”

Section: Introductionmentioning

confidence: 99%

Screw placement in slipped upper femoral epiphysis: Is good the enemy of better?

Jamil

Allami

Varghese

et al. 2007

Journal of Children's Orthopaedics

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Introduction and aims A single hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours the placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes to avoid the risks of chondrolysis and avascular necrosis (AVN). We investigated the correlation between different positions of the screw in the femoral head and the prevalence of AVN, chondrolysis, late slippage and the time to epiphyseal closure.Methods The clinical notes and radiographs of 38 consecutive patients (61 hips) who underwent single screw fixation for SUFE were evaluated retrospectively with a mean follow-up of 36 months. Two-way ANOVA and the post hoc test was performed to analyse the correlation between the different variables and the outcome at the 5% level of significance.Results There were 16 acute slips, 18 chronic slips and ten acute-on-chronic slips. Seventeen slips were treated prophylactically. Mild slip was encountered in 39 hips, moderate slip in four and severe slip in one. The centralcentral position was only achieved in 51% of cases. The most significant results of the study were as follows: (1) no significant difference between the time to epiphyseal closure and the position of the screw, and (2) no late slippage or chondrolysis was observed in our series.Conclusion Our results showed that the positioning of the screw other than in the centre of the femoral head has the ability to provide physeal stability and has no correlation with the timing to closure of the epiphysis and the risk of avascular necrosis or chondrolysis. We therefore recommend that other positions be considered if the ''optimal central-central position'' is not initially achieved -specifically for the treatment of mild slip -as the potential hazards from several attempts to achieve the optimum position outweigh the benefits.

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Comparative Study of Pinning In Situ and Open Epiphysiodesis in 105 Patients with Slipped pital Femoral Epiphyses

Cited by 29 publications

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The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

Vergleich der Therapie der Epiphyseolysis capitis femoris mit Kirschner-Drähten und kanülierten Titanschrauben

Screw placement in slipped upper femoral epiphysis: Is good the enemy of better?

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