Continued growth after fixation of slipped capital femoral epiphysis

Abstract

PurposeWhen treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE.MethodsSixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4–15.7 years), were included. The slipped hip was fixed with a smooth pin with a hook, and the non-slipped hip was prophylactically pinned. At the time of surgery, tantalum markers were installed bilaterally on each side of the growth plate through the drilled hole for the pin. Examination with radiostereometric analysis (RSA) was performed postoperatively and at 3, 6 and 12 months. The position of the epiphysis in relation to the metaphysis was calculated.ResultsAt 12 months, the epiphysis moved caudally, median 0.16 mm and posteriorly 2.28 mm on the slipped side, in comparison to 2.28 cranially and 0.91 mm posteriorly on the non-slipped side, p = 0.003 and p = 0.030, respectively. Both slipped and non-slipped epiphysis moved medially, 1.52 and 1.74 mm, respectively. A marked variation in the movement was noted, especially on the slipped side.ConclusionsThe epiphysis moved in relation to the metaphysis after smooth pin fixation, both on the slipped side and on the prophylactically fixed non-slipped side, implying further growth. The RSA method can be used to understand remodelling after ‘growth-sparing’ fixation of SCFE.

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

“…Other studies showed that growth-preserving stabilization of the SCFE and the healthy contralateral hip leads to simultaneous physis fusion of both hips (at about 17 months postoperatively). The healthy contralateral hips present more prominent growth, inferring that some injury of the affected growth plate may be permanent, or the slipped physis is primarily deficient [4,8,9].…”

“…SCFE is a disease of the growing skeleton. It is expected that the remaining growth of the hip will be affected, either primarily, by the process that caused the slip, or secondarily, by the surgical technique or by the delay of treatment [3][4][5][6][7][8][9][10].…”

“…The femoral neck is shorter and thicker compared to the healthy contralateral hip. The femoral neck resembles the grip of a pistol [1,6,9,[20][21][22]24,28,31,38,39].…”

Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis

“…Six studies reported on 464 hips that were treated with bone peg epiphysiodesis [ 37 – 42 ] (Table 5 ). Nineteen studies (714 hips) reported on pinning in situ using a single screw [ 3 , 23 , 30 – 32 , 43 – 55 , 65 ] (Table 6 ). Six studies (273 hips) reported on fixation in situ using multiple smooth pins [ 35 , 42 , 44 , 45 , 47 , 56 ] (Table 7 ).…”

“…Seven studies (95 hips) reported on safe surgical dislocation using the Ganz technique [ 43 , 51 , 52 , 67 – 70 ] (Table 9 ). Although nine studies reported on screws that allow continued growth, only three met our inclusion criteria [ 23 , 54 , 55 ]. These were further analysed for their effect on growth of the femoral neck.…”