Leg length discrepancy after in situ fixation with screw for slipped capital femoral epiphysis

Abstract

Although leg length discrepancy (LLD) commonly occurs following in situ fixation with screws for slipped capital femoral epiphysis (SCFE), the literature regarding this issue is scarce. The purpose of this study was to evaluate the degree of LLD in patients who had been treated with in situ fixation with screws and to identify the risk factors for the development of LLD. We retrospectively reviewed 44 patients (mild slip 24, moderate slip, 20) who were treated with in situ fixation with screws for SCFE. The mean age at surgery was 12.2 years and the mean follow-up period was 6.9 years. We investigated the relationship between the final LLD, articulotrochanteric distance difference (ATDD) at skeletal maturity, and various clinical and radiographic parameters using linear regression analysis. The mean values of LLD and ATDD were 13.1 and 11.1 mm, respectively. The LLD and ATDD was significantly higher in patients with moderate slips than in those with mild slips. The degree of slip angle was associated with the degree of LLD only. While there was no significant factor affecting the LLD in moderate slips, younger age and a larger degree of slip angle were associated with the degree of LLD. The degree of slip was the only factor that affected LLD in patients with mild or moderate SCFE who underwent threaded screw fixation. Age at surgery was not associated with LLD, and there were no factors related to the degree of LLD in mild slip. Monitoring for LLD may only be necessary for patients with moderate slip who are treated with in situ screw fixation.