Natural History of Slipped Capital Femoral Epiphysis

Mathew, Smitha; Larson, A. Noelle

doi:10.1097/bpo.0000000000001369

Cited by 48 publications

(50 citation statements)

References 40 publications

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“…Epiphysiolysis of the femoral head is the most common hip disease in the pediatric population [ 13 , 20 ], with an incidence of 0.2–0.3 per 100,000 children aged 10–14 years [ 1 ]. The aetiology of SCFE is multifactorial and includes endocrine disorders, growth spurs and obesity [ 2 , 4 , 7 , 21 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Longo

Papalia

Salvatore

et al. 2021

BMC Musculoskelet Disord

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Background Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10–14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. Methods Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. Results From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). Conclusion National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. Level of evidence III

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Section: Discussionmentioning

confidence: 99%

“…The former is treated using in situ closed screw fixation; instead, open reduction and fixation are usually adopted for unstable forms [ 10 ]. However, the proper treatment for unstable forms is still debated [ 11 – 13 ]. The major problem of this disease is the rapidity of diagnosis and the timing of surgery.…”

Section: Introductionmentioning

confidence: 99%

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Longo

Papalia

Salvatore

et al. 2021

BMC Musculoskelet Disord

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“…Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder, affecting 1 in 10,000 to 20,000 children [ 1 – 5 ]. The pathogenesis of SCFE is believed to be multifactorial; obesity [ 6 – 8 ] and abnormal morphology [ 4 ] at the hip joint have been shown to play a contributing role.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted subcapital correction osteotomy in slipped capital femoral epiphysis using individualized drill templates

et al. 2021

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Background Subcapital osteotomy by means of surgical hip dislocation is a treatment approach offered for moderate-to-severe cases of Slipped Capital Femoral Epiphysis (SCFE). This procedure is demanding, highly dependent on the surgeon’s experience, and requires considerable radiation exposure for monitoring and securing the spatial alignment of the femoral head. We propose the use of individualized drill guides as an accurate method for placing K-wires during subcapital correction osteotomies in SCFE patients. Methods Five CT scans of the hip joint from otherwise healthy patients with moderate-to-severe SCFE were selected (ages 11–14). Three dimensional models of each patient’s femur were reconstructed by manual segmentation and physically replicated using additive manufacturing techniques. Five orthopaedic surgeons virtually identified the optimal entry point and direction of the two threaded wires for each case. 3D printed drill guides were designed specific to each surgical plan, with one side shaped to fit the patient’s bone and the other side containing holes to guide the surgical drill. Each surgeon performed three guided (using the drill guides) and three conventional (freehand) simulated procedures on each case. Each femur model was laser scanned and digitally matched to the preoperative model for evaluation of entry points and wire angulations. We compared wire entry point, wire angulation, procedure time and number of x-rays between guided and freehand simulated surgeries. Results The guided group (1.4 ± 0.9 mm; 2.5° ± 1.4°) was significantly more accurate than the freehand group (5.8 ± 3.2 mm; 5.3° ± 4.4°) for wire entry location and angulation (p < 0.001). Guided surgeries required significantly less drilling time and intraoperative x-rays (90.5 ± 42.2 s, 3 ± 1 scans) compared to the conventional surgeries (246.8 ± 122.1 s, 14 ± 5 scans) (p < 0.001). Conclusions We conclude that CT-based preoperative planning and intraoperative navigation using individualized drill guides allow for improved accuracy of wires, reduced operative time and less radiation exposure in simulated hips. Clinical relevance This preliminary study shows promising results, suggesting potential direct benefits to SCFE patients by necessitating less time under anesthesia and less intra-operative radiation exposure to patients, and increasing surgical accuracy.

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“…[1][2][3] While SCFE usually presents as a stable epiphyseal injury 2,4,5 , its natural history is poorly understood. 6 In situ fixation with a single screw is the preferred treatment. 1,7,8 Possible complications, particularly in unstable fractures, include avascular necrosis, chondrolysis, femoroacetabular impingement (FAI), and degeneration of the hip joint.…”

Section: Introductionmentioning

confidence: 99%

Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

Kaçmaz¹,

Uzakgider²,

Zhamilov³

et al. 2021

FORBES

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Objective: This study has investigated the amount of bone remodeling in patients with a slipped capital femoral epiphysis (SCFE) treated with in situ fixation until closure of the epiphysis and the factors affecting remodeling. Method: Patients who underwent surgery for SCFE between January 2010 and January 2015 were retrospectively screened: Twenty-four male and 7 female patients (mean age 12.6 ± 1.9 years) were included in the study. Gender, age, history, and laterality of trauma, duration of hip pain (acute, chronic, acute on chronic background), and hip radiographs were evaluated. The Southwick and alpha angles were measured, and the factors affecting remodeling were assessed. The statistical analyses were conducted using SPSS 25.0 (IBM Corp., Armonk, NY); 95% confidence levels were calculated and p < 0.05 was considered to indicate statistical significance. Results: The preoperative displacement angles measured on the anteroposterior and lateral radiographs were 15.03° ± 9.1° and 25.93° ± 14.1° and at the last follow-up they were 11.63° ± 8.7° and 21.6° ± 12.1°, respectively. The alpha angles measured on the lateral radiographs preoperatively and at the end of follow-up were 52.33° ± 11.6° and 47.87° ± 11.8°, respectively. Significant remodeling was reflected in the angles measured on the anteroposterior and lateral X-ray images. Greater preoperative displacement angle was associated with less remodeling. Conclusion: Preoperative displacement affects the degree of postoperative remodeling. In patients with severe epiphyseal displacement, open reduction is an option but in situ pinning should be considered in that it is less invasive and more physiological.

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Natural History of Slipped Capital Femoral Epiphysis

Cited by 48 publications

References 40 publications

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Computer-assisted subcapital correction osteotomy in slipped capital femoral epiphysis using individualized drill templates

Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

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