Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws

Pretell-Mazzini, Juan; Rodríguez-Vega, Víctor; Muñoz-Ledesma, Jorge; Andrés-Esteban, Eva María; Marti-Ciruelos, Rafael; González-López, J.L.; Mano, Ángel Curto de la

doi:10.1007/s11832-012-0425-z

Cited by 9 publications

(13 citation statements)

References 17 publications

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“…On the other hand, pins removal, performed as soon as the physis is closed, is reported to be a safe procedure based on a low rate of complications such as post-removal fractures, infection and scar issues ( 58 ).…”

Section: Discussionmentioning

confidence: 99%

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

et al. 2022

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The aim of this systematic review is to assess the role of the prophylactic fixation of contralateral unaffected hip in unilateral slipped capital femoral epiphysis (SCFE) in children, focusing on the possible complications of this surgical procedure. A systematic review of medical literature was conducted, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement, to analyse the complications of prophylactic contralateral hip fixation in unilateral paediatric SCFE. We registered the complications reported in the included studies, scoring their severity according to the orthopaedic adaptation of Clavien–Dindo classification. From 1695 studies primarily identified, 14 studies were finally included: 1 prospective cohort study, 4 retrospective case-control studies and 9 retrospective case series, with a total of 811 children diagnosed with unilateral SCFE and treated on the unaffected contralateral hip. Grade IV complications were very rare (0.37%), while the rate of grade III events was 8%. No death was recorded. The most frequent complication was unplanned further surgery (6.29%) that was an epiphyseal refixation, owing to the physiologic growth of the proximal femur, in 42 cases. Cannulated screws fixation showed to have a lower major complication rate than pinning with K-wires, 5.37% vs 17.95%. The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.

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Section: Discussionmentioning

confidence: 99%

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

et al. 2022

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“…14 Implants placed for SCFE are notoriously difficult to remove, with a complication rate of 34%, with some authors reporting rates as high as 61% and 83% with older implant models. [14][15][16] The over reaming technique appears to be a safe method of retrieval when traditional methods fail. Further studies are warranted to investigate the risk of fracture after reaming as well as screw design characteristics that contribute to challenging removal.…”

Section: Discussionmentioning

confidence: 99%

“…In a series of 38 SCFE screw removal procedures with 1.6-year follow-up there were no fractures after screw removal. 16 We imagine the risk for fracture after coring should theoretically be greater than uncomplicated screw removal. One should, therefore, make attempts to avoid over reaming, and once committing to it, select the smallest size reamer available to minimize structural bone loss.…”

Section: Comparison To Other Methodsmentioning

confidence: 99%

“…13 Implants placed for SCFE are notoriously difficult to remove, with a complication rate of 34%, with some authors reporting rates as high as 61% and 83% with older implant models. [14][15][16] The factors behind difficult screw removal is often attributed to metal composition (titanium vs. stainless steel) and thread length (partially vs. fully threaded, see Figure 1). 17,18 Stainless steel screws have been the preferred choice for many years, as titanium screws have osseointegration and thus require more torque to remove.…”

Section: Key Pointsmentioning

confidence: 99%

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SCFE Screw Removal with Coring Reamer

Mayers¹,

Hayes²,

Wheatley³

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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In situ percutaneous pinning of a Slipped Capital Femoral Epiphysis (SCFE) is a safe and effective surgical treatment to prevent deformity progression in children.1 Implant options for “pinning” include Kirschner wires, Knowles pins, but more commonly, cannulated fully and partially threaded screws. Cannulated screws exist with various designs available in both stainless steel or titanium. Routine implant removal after termination of growth around puberty is controversial. Some surgeons perform removal to reduce risk of fracture associated with an increased stress riser, reduce risk of trochanteric bursitis, or accommodate secondary hip procedures such as future arthroplasty.2,3,4 A rarer indication for removal is one out of necessity for correctional osteotomies in the treatment of chronic symptomatic SCFE deformity. Difficulty with hardware removal is well documented in SCFE patients.4–8 Most commonly noted are cases of a lodged and stripped screw that is not retrievable via standard method of screw reversal.7,5,9,10 The challenges of removal as well as the underlying causes have been studied, implicating metal type and some parameters of thread design.9 Screw manufacturers responded with development of harder, smoother metals to prevent ingrowth with the addition of reverse cutting threads to aid in backing out.11 Some surgeons describe their own means of responding to the problem by either leaving retained hardware, hollow milling to permit engagement with vice grips, and over reaming to the level of the proximal threads.9 In this article we describe our technical tips for removal of a stuck 7.0 cannulated cancellous SCFE screw that was lodged in a patient who required surgical hip dislocation, femoral neck osteoplasty, and relative femoral neck lengthening for treatment of her chronic SCFE deformities 38 months from implantation. We describe screw removal failure that ultimately required over reaming with a 10 mm coring reamer to retrieve the screw. A written and video technical guide is provided for evaluating the opportunities and obstacles of how similar cases can be addressed with similar success.

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“…Bone covering of the screw head can equally complicate implant removal. Therefore, several authors recommend using fully threaded (no cutting back mechanism) stainless steel screws and to perform the removal as soon as the physis is closed (125-126-127-128-129-130-131).…”

Section: Fixation Of the Epiphysis: Techniques Benefits And Drawbacksmentioning

confidence: 99%

Current Concepts in Management of Slipped Capital Femoral Epiphysis

Bittersohl

Hosalkar²,

Zilkens

et al. 2014

HIP International

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Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive.

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Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws

Cited by 9 publications

References 17 publications

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

SCFE Screw Removal with Coring Reamer

Current Concepts in Management of Slipped Capital Femoral Epiphysis

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