Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading

Sailhan, Frédéric; Courvoisier, Aurélien; Brunet, O.; Chotel, Franck; Bérard, J

doi:10.1007/s11832-010-0324-0

Cited by 32 publications

(42 citation statements)

References 32 publications

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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%

“…To reach this target, an ideal method in SCFE should stabilize the epiphysis without causing unwanted premature closure of the physis. Histologic, ultrastructural, and clinical studies post stabilization reported remodeling with normalization of the physis [ 15 – 21 ]. Remodeling due to the growth of the neck can reduce or eliminate head/neck incongruities.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

et al. 2017

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“…As secondary loss of fixation is rarely observed when screws are used instead of pins, screw fixation has increasingly been performed in SCFE in recent years. Recent studies suggest that the damage to the physis caused by screw fixation might be far less than assumed previously [15][16][17], although no results have been published on prophylactic fixation of the contralateral asymptomatic hip. The aim of this retrospective matched-pair study was to compare the longitudinal growth of the femoral neck and accompanying deformities such as coxa vara in patients with screw fixation with those with Kirschner-wire (K-wire) fixation of the asymptomatic contralateral hip in SCFE.…”

Section: Introductionmentioning

confidence: 87%

Significantly lower femoral neck growth in screw fixation of the asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis

Wölfle-Roos

Urlaub

Reichel

et al. 2016

Journal of Pediatric Orthopaedics B

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There is an ongoing debate on which fixation technique should be preferred for the prophylactic fixation of the asymptomatic contralateral hip in slipped capital femoral epiphysis (SCFE). In the case of Kirschner-wire (K-wire) fixation, there is a possibility of secondary loss of fixation because of longitudinal growth of the physis, whereas in screw fixation, physeal growth of the femoral neck might be impaired. The aim of this matched-pair study was to compare the longitudinal growth of the femoral neck in screw fixation versus K-wire fixation of the asymptomatic contralateral hip in SCFE. All 18 patients (female:male=3:15), who had undergone screw fixation of the asymptomatic contralateral hip between 9/2001 and 9/2011, were matched according to age, bone age, sex, and time to follow-up to another 18 patients with K-wire fixation. The length of the femoral neck of the contralateral hip was measured in parallel to either screw or K-wire from the apex of the femoral head to the opposite cortical bone. The ratio of the femoral neck length measured directly after surgery and on follow-up was defined as femoral neck growth. There was no significant difference between groups with respect to age, modified Oxford Bone age score, and time to follow-up. We found a significant difference in femoral neck growth between patients with screw fixation (5.5 ± 4.3%) compared with K-wire fixation (8.9 ± 5.7%, P = 0.048 matched Wilcoxon test). The difference in femoral neck growth of patients with K-wire or screw fixation of the contralateral asymptomatic hip in SCFE was small, but statistically significant. Thus, despite high rates of secondary loss of fixation, K-wire fixation should still be considered, especially in very young patients.

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“…Die Gleitschraube bietet eine sichere und dauerhafte Stabilisierung der Kopfepiphyse, fördert jedoch im Gegensatz zu den im angloamerikanischen Bereich verwendeten Zugschrauben nicht den vorzeitigen Verschluss der Wachstumsfuge [1]. In der untersuchten Patientenkohorte wurde in keiner der beiden [4] als auch Hackenbroch et al [1] keinen Unterschied in der ATD zwischen erkrankten und prophylaktisch versorgten Hüften mit Gleitschraubenversorgungen. Hinsichtlich weiterer Implantatversorgungen di- vergieren die Angaben von geringen [6] bis sehr starken Verminderungen der ATD [3].…”

Section: Hüftkopfdeformierungunclassified

“…Die damit einhergehende Wiederherstellung der Hüftfunktion und Reduktion des Risikos späterer degenerativer Veränderungen ist mit der Notwendigkeit der Komplikationsvermeidung wie avaskulärer Nekrosen und Chondrolysen verbunden [2,3]. Obwohl eine Vielzahl konservativer Behandlungsmöglichkeiten beschrieben wurde [4], wird die operative In-situ-Fixation mit Stabilisierung der oberen Femurepiphyse mehrheitlich befürwortet. Dennoch wird die Art und Weise der operativen Stabilisierung weiterhin kontrovers diskutiert [5], ebenso die Frage, ob man ein weiteres Wachstum der Fuge zulassen [6] oder einen möglichst zügigen Fugenschluss anstreben sollte [7].…”

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Wachstum und Deformität nach In-situ-Fixation der Epiphyseolysis capitis femoris

2013

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The results of this study imply that further growth of the proximal femur after insertion of a sliding screw for in situ stabilisation of mild to moderate slipped capital femoral epiphysis does occur. Furthermore, an increase of deformity during follow-up through screw fixation as compared to pinning was not noticed. Hence, the assumption that screw fixation leads to permanent physeal impairment cannot be confirmed. The consideration of these results may be helpful for implant selection as well as indicating prophylactic surgery for non-affected hips.

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Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading

Abstract: Fixation of the epiphysis using proximally threaded screws allows the preservation of femoral neck growth. The cannulated screw with proximal threading seems to be a safe and relevant implant to help to restore a close-to-normal hip at skeletal maturity.

Cited by 32 publications

References 32 publications

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

Significantly lower femoral neck growth in screw fixation of the asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis

Wachstum und Deformität nach In-situ-Fixation der Epiphyseolysis capitis femoris

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