Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

Abstract

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.

Outcome of the modified Dunn procedure in severe slipped capital femoral epiphysis

“…In situ fixation in the treatment of SCFE had been traditionally defined as a safe and reliable method in mild SCFEs [ 10 , 11 ]. The use of this surgical technique with a modified screw allows residual growth of the femoral neck following mild SCFE and permits restoration of the anatomy of the proximal femur while avoiding development of FAI following mild SCFE [ 32 ]. However, recent evidence suggests that this procedure does not address the posterior tilt and rotation, or translation of the epiphysis in severe cases [ 7 ].…”

Is prophylactic fixation preferable to active surveillance of the unaffected contralateral hip in unilateral slipped capital femoral epiphysis?- A Systematic Review

“…In 2015, Clement et al published a retrospective cohort comparison study comparing prophylactic fixation with active surveillance for the unaffected contralateral hip in SCFE [14] . From January 2000 to December 2010, they identified a total of 86 patients with a mean follow up 8 years [3][4][5][6][7][8][9][10][11][12][13] . These were divided into the prophylactic fixation group [PF] or the active surveillance group [AS] at the discretion of the admitting consultant.…”

“…Follow-up beyond 12 months was done if clinically indicated though these indications are not mentioned. Mean follow up for 2.4 years [1-8.8] in PF group and 2.9 years [1][2][3][4][5][6][7][8][9] in AS group. All fixations were done by one of three consultants or their trainees under supervision.…”

“…Average age of those with subsequent slip was 13 years and those without were 12.9 years. The average duration between slips was 8.4 months [3][4][5][6][7][8][9][10][11][12] with an outlying 27 months for the slip in the PF group. Regarding complications, there were no cases of AVN or chondrolysis.…”

“…Both views have well established merits and demerits but a clear consensus is yet to emerge [6] . The prophylactic fixation approach is based on the increased likelihood of subsequent slip, up to 2335 times more in children diagnosed with unilateral SCFE, and the attempt to offset the complications of an untreated subsequent slip [2,7] . The active surveillance approach is based on the notion that prophylactic surgery on a "normal" hip is unnecessary and does not justify the risks associated with it [8,9] .…”