Does Skeletal Maturity Predict Sequential Contralateral Involvement After Fixation of Slipped Capital Femoral Epiphysis?

Koenig, Karl; Thomson, Jeffery D.; Anderson, Kane L.; Carney, Brian T.

doi:10.1097/bpo.0b013e3181558bd9

Cited by 28 publications

(17 citation statements)

References 11 publications

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“…The rate of subsequent slip in our series was 15%, which is comparable to the rates of other reports of predominantly white patients, similar to our patient population (Table 5). Excluding patients presenting with bilateral disease, reported rates of documented, symptomatic childhood progression to bilateral disease in children range from 9% to 36% [3,6,10,17,22,33,42]. Thus, our 15% rate of subsequent slip is similar to the reported literature.…”

Section: Discussionsupporting

confidence: 81%

“…Patients may complain of limited motion in the hip and an external foot progression angle. Excluding patients presenting with bilateral disease, reported rates of documented, symptomatic childhood progression to bilateral disease in children range from 9% to 36% [3,6,10,17,22,33]. Considering asymptomatic disease, other series report a much higher rate of bilateral disease at up to 36% to 79% of patients with unilateral slips developing bilateral disease evident by deformity on radiograph at skeletal maturity [4,11,13].…”

Section: Discussionmentioning

confidence: 99%

“…avascular necrosis and severe hip deformity [2]. For the most part, a low rate of severe slips (0%-3%) has been reported for the contralateral hip [13,17,24], perhaps since children and parents are aware of the condition and able to report for treatment as soon as symptoms develop. Thus, since severe slips are rare, expectant management of a contralateral hip at risk for slipping has been well accepted, particularly for older children and those without associated risk factors of an endocrinopathy.…”

Section: Introductionmentioning

confidence: 99%

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The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear. Questions/purposes We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning. Methods We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2-43 years).

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…However, these authors did find age \ 12 years to be a major risk factor. Although three other investigations supported this finding of younger age as a risk factor for BL-SCFE [28,30,45], Koenig et al [24] reported that age, sex, slip stability, slip chronicity, modified Oxford bone age, physeal slope angle, and slip angle were not associated with the development of BL-SCFE in a series of 71 patients with UL-SCFE [24]. We found patients presenting with an acute slip are at risk for sequential BL-SCFE and have a 2.5 chance of developing BL-SCFE compared with those who present with a chronic slip.…”

Section: Discussionmentioning

confidence: 64%

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

Nasreddine

Heyworth

Zurakowski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE. Questions/purposes We therefore determined whether (1) BMI percentile was a risk factor for BL-SCFE; and (2) postoperative increases and/or decreases in BMI percentile influenced the risk for BL-SCFE. Methods We retrospectively reviewed the records of 502 patients surgically treated for SCFE and identified 138 (27%) with BL-SCFE and 364 (73%) with unilateral SCFE (UL-SCFE); 173 patients, 60 (35%) with BL-SCFE and 113 (65%) with UL-SCFE met our inclusion criteria. Risk factors included sex, age, slip stability, slip chronicity, slip angle, and obesity. Percentile BMI was recorded at the time of first SCFE surgery, at the time of last followup for patients undergoing UL-SCFE, and at the time of second SCFE surgery for patients undergoing BL-SCFE. Results Sex, age, slip stability, and slip angle were not associated with BL-SCFE. Postoperative obesity (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2-9.7) and acute slip chronicity (OR, 2.9; 95% CI, 1.3-6.7) had higher risks for sequential BL-SCFE. Obese patients who became nonobese postoperatively had a decreased risk of sequential BL-SCFE compared with those who remained obese (OR, 0.16; 95% CI, 1.2-116.5). Conclusions Only postoperative obesity and an acute slip were risk factors for sequential BL-SCFE. BMI reduction to lower than the 95% percentile after SCFE surgery was associated with lower risk for BL-SCFE development. The data suggest early supervised therapeutic weight management programs for patients treated for UL-SCFE are important to reduce risk of subsequent SCFE. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…These 18 patients were matched according to age, sex, time to follow-up, and bone age measured on the modified Oxford Bone Age score [18,19] to another 18 patients with K-wire fixation of the asymptomatic contralateral hip. The decision in favor of either screw or K-wire fixation was made mainly on the basis of the date of surgery: initially, K-wire fixation was performed in all patients, but it was gradually abandoned in favor of screw fixation in view of reports of high rates of secondary loss of fixation in the literature.…”

Section: Patientsmentioning

confidence: 99%

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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Does Skeletal Maturity Predict Sequential Contralateral Involvement After Fixation of Slipped Capital Femoral Epiphysis?

Abstract: Level IV.

Cited by 28 publications

References 11 publications

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

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

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