Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement

Ulici, Alexandru; Carp, Madalina; Tevanov, Iulia; Nahoi, Catalin Alexandru; Sterian, Alin Gabriel; Cosma, Dan

doi:10.1177/0300060517731683

Cited by 15 publications

(9 citation statements)

References 23 publications

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“…Un resultado sorprendente fue que en promedio los DEFP estables estaban menos desplazados, pero los pacientes con DEFP inestables tuvieron mejores resultados de calidad de vida mediante iHOT-12. Además, los DEFP estables desarrollaron mayor proporción de PFA, lo que contrasta con lo informado tanto por Ulici y colaboradores, como por Lang y colaboradores (9) . A pesar de esto, los pacientes con PFA tuvieron un iHOT-12 promedio de 62, muy superior al observado en el estudio de Sansone y colaboradores, donde el iHOT-12 preoperatorio a una artroscopia de cadera por PFA era en promedio de 43 (19) .…”

Section: Discussionunclassified

“…Definimos síndrome de pinzamiento femoroacetabular cuando el paciente presentó dolor de cadera (TestPFA+) y ángulo alfa >55º (deformidad tipo CAM) (27) . Al espacio femoroacetabular menor de 3 mm o ms del 50% de reducción del espacio articular lo definimos condrólisis (9) . Para definir NAV, utilizamos la clasificación radiológica de Ficat teniendo en cuenta la destrucción epifisaria, con estadios I a IV (28) .…”

Section: Examen Radiológicounclassified

“…La clasificación de Loder, basada en la estabilidad de la fisis, es la más utilizada en la actualidad (7) . El DEFP estable representa aproximadamente el 75%-90% (5,8,9) . Los DEFP inestables son menos frecuentes, pero tienen una tasa de complicaciones más elevada (9)(10)(11) .…”

Section: Introductionunclassified

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Epifisiólisis de fémur proximal: Resultados y calidad de vida

Filippini

Pagano

Pérez

et al. 2020

RMU

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Section: Discussionunclassified

Section: Examen Radiológicounclassified

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Epifisiólisis de fémur proximal: Resultados y calidad de vida

Filippini

Pagano

Pérez

et al. 2020

RMU

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“…These classifications have an impact on the choice of the therapeutic modality and the prognosis ( Table 3). Chronic evolution, unstable form, severe displacement are independent factors of poor prognosis in terms of Avascular necrosis (AVN) [21], chondrolysis, osteoarthritis or FAI.…”

Section: A B Cmentioning

confidence: 99%

Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review

Mbonda¹,

Tchuenkam²,

Tochie³

et al. 2019

TOORTHJ

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Background: Slipped Capital Femoral Epiphysis (SCFE) is an incapacitating orthopedic disease, particularly affecting older children and adolescents and caused by the sliding of the proximal femoral epiphysis on the metaphysis. SCFE has a clinical polymorphism, compounded with a certain diagnostic variability among health practitioners and the relatively high cost of its surgical management contribute to the diagnostic delay observed in most developed countries as well as developing ones. Herein, we report the case of SCFE in an adolescent Cameroonian, with emphasis on its diagnostic and therapeutic challenges in Low and Middle-Income Countries (LMICs), in a bit to improve on timely recognition and management by clinicians in these settings. Case Presentation: A 10-year-old girl has presented with unilateral right thigh pain of more than one year duration associated with a limping gait and no fever. Before the referral to our health facility, she consulted several general practitioners in rural areas and pediatricians in the city with no definite diagnosis. On the basis of the clinical and the imaging studies, the diagnosis of stable right SCFE with moderate displacement was made. Under general anesthesia, the patient underwent open reduction and internal fixation with three pins under c-arm fluoroscopy. Clinical and radiological follow-up till one year after surgical intervention were satisfactory. The pins were removed after one year of fixation confirming a good bone fusion in plain x-ray. Her clinical examination and radiological follow-up three years after removal of the pins were satisfactory. Conclusion: The case report illustrates that SCFE often a missed diagnosis in LMICs. This is worrisome because delayed diagnosis may lead to long-term complications such as avascular necrosis and early degenerative joint disease. Although the above case was missed by several clinicians and finally diagnose late, the present case highlights the need for a high index of clinical suspicion in order to timely diagnose and timely manage SCFE to avert potential long-term physical disabilities and psychological trauma in children.

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“…The degree of slip severity has been significantly correlated with delays in diagnosis in several studies [1,2,5,7,9,13,44]. A higher slip severity increases the likelihood of premature osteoarthritis and additional surgeries (e.g., osteotomies, and in some cases total hip replacements), whereas a patient diagnosed with a mild slip typically has a better outcome [2,[45][46][47][48]. Furthermore, a study from Fedorak et al (2018) showed a direct association between a longer time from symptom onset to diagnosis and a greater chance of more invasive surgery [1].…”

Section: Introductionmentioning

confidence: 99%

Examining delays in diagnosis for slipped capital femoral epiphysis from a health disparities perspective

2022

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Slipped Capital Femoral Epiphysis (SCFE) is a skeletal pathology affecting adolescents which requires timely surgery to prevent progression. Delays in diagnosis and treatment of SCFE can negatively affect patient prognosis, and few studies have examined how health disparities and barriers to care may influence these delays. In particular, only a handful of studies have included a Hispanic patient sample, despite this ethnic group’s increased risk for the disease and unique barriers to care. A retrospective chart review was conducted for 124 patients surgically treated for idiopathic SCFE from January 2010 to September 2017. Patient data included age, facility and date of diagnosis, sex, BMI, race and ethnicity, Southwick slip angle, and insurance type. Results indicated that patients with private insurance were more likely to present with a mild slip than patients who were insured by Medicaid or uninsured, while patients without insurance were more likely to have severe slips. Patients without insurance also had a significantly higher mean slip than patients with insurance. The relationship between insurance status and slip angle degree was significant independent of race, even though Hispanic individuals were significantly more likely to have Medicaid or be uninsured. All patients without insurance, and a majority of those with Medicaid, were diagnosed in the emergency department. Time to diagnosis and slip angle were positively correlated, which suggests that longer delays led to increase of the slip angle, consistent with previous findings. Time to diagnosis and BMI were also correlated, which may be tied to socioeconomic factors, but the possibility of weight bias should not be dismissed. These results suggest that socioeconomic status and other factors may have contributed to barriers to care which led to delays in diagnosis and thus more severe slips. Future SCFE research should include health disparities variables to better inform treatment and prognosis.

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Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement

Cited by 15 publications

References 23 publications

Epifisiólisis de fémur proximal: Resultados y calidad de vida

Epifisiólisis de fémur proximal: Resultados y calidad de vida

Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review

Examining delays in diagnosis for slipped capital femoral epiphysis from a health disparities perspective

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