Similar femoral growth and deformity with one screw versus two smooth pins for slipped capital femoral epiphysis

Megaloikonomos, Panayiotis D.; Mavrogenis, Andreas F.; Panagopoulos, Georgios N.; Igoumenou, Vasilios G.; Zampakides, Christos; Pasparakis, D.

doi:10.1007/s00264-018-4058-9

Cited by 6 publications

(12 citation statements)

References 25 publications

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“…Wird eine solche Deformität in einer symptomatischen Hüfte eines jugendlichen Patienten detektiert, stellt sie eine dringende Indikation für eine chirurgische Behandlung dar, da die Epiphyse durch Stabilisierung vor einem zunehmenden Abrutsch geschützt werden muss. Auch nach einer Operation, insbesondere nach „in situ pinning“, behalten diese Hüften eine sekundäre Cam-Deformität, die zum Teil durch „remodelling“ gebessert wird, aber jedenfalls einer genauen Beobachtung bedarf [ 17 ]. Andere sekundäre Ursachen eines FAIS stellen Folgezustände nach Morbus Perthes, Frakturen oder entzündliche Gelenkerkrankungen dar.…”

Section: Prävalenz Und Pathogeneseunclassified

Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln?

et al. 2022

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Zusammenfassung Hintergrund Das Femoroazetabuläre Impingement-Syndrom (FAIS) ist eine relevante Ursache für Leistenschmerzen beim Jugendlichen. Insbesondere sind Sportler betroffen. Ziel der Arbeit Die Arbeit soll einen evidenzbasierten Hintergrund für Beratung und Therapie des FAIS beim Adoleszenten bieten. Material und Methoden Anhand der aktuellen Literatur wurde eine Übersicht zu Prävalenz und Pathogenese, Abklärung und Diagnostik sowie therapeutischen Empfehlung des FAIS beim Adoleszenten erarbeitet. Ergebnisse und Diskussion Das FAIS beim Jugendlichen betrifft vor allem sportlich aktive Patienten. Bestimmte Sportarten begünstigen die Entstehung eines FAIS. Cam-Impingement, Pincer-Impingement und kombiniertes FAIS sind die häufigsten Entitäten in dieser Altersgruppe. Die Cam-Morphologie entsteht kurz vor Schluss der proximalen Femurwachstumsfuge. Beim Cam-Impingement muss die Epiphyseolysis capitis femoris (ECF) von der primären Cam-Morphologie unterschieden werden. Die ECF verlangt eine rasche operative Versorgung mit Stabilisierung der Epiphyse, während das primäre Cam-Impingement elektiv abgeklärt werden kann und ein konservativer Behandlungsversuch sinnvoll ist. Schäden an Labrum und Knorpel werden regelhaft beobachtet. Eine systematische radiologische Abklärung mittels Projektionsröntgen und MRT ist obligat, um einen adäquaten Therapieplan zu entwickeln. Bei jugendlichen Patienten mit FAIS sollte immer ein konservativer Therapieversuch erfolgen. Ist dieser nicht erfolgreich, ist die operative Sanierung mit Hüftarthroskopie indiziert. Die postoperativen Ergebnisse zeigen bei Jugendlichen sehr gute Erfolge mit rascher Besserung der Beschwerden, geringen Komplikationen und einer hohen „Return-to-sport“-Rate.

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Section: Prävalenz Und Pathogeneseunclassified

Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln?

et al. 2022

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“…Positive longitudinal growth after fixation with various growing screws is well documented [12][13][14]16,23,[27][28][29]. However, few studies include a comparison against the standard screw [30,31]. Superior growth has been recorded in a very young cohort of five patients aged less than 10 years old treated with three different growing screws [31].…”

Section: Radiological Assessmentmentioning

confidence: 99%

Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study

Mills

Flowers

Agrawal

et al. 2020

Journal of Pediatric Orthopaedics B

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The most common treatment for slipped capital femoral epiphysis worldwide is in situ fixation with a threaded screw. Un-threaded screws are designed to prevent slip progression without hindering residual growth of the proximal femur. This study aimed to compare growth, remodelling and long-term outcomes after fixation with un-threaded screws and a matched cohort of patients treated with a standard screw. Six patients (nine hips) treated with un-threaded screws and 16 patients (21 hips) treated with standard screws matched for age, skeletal maturity, sex and Southwick angle were recruited. Clinical records were reviewed for patient demographics, medical history and complications. Radiographs were reviewed for residual growth and time to physeal closure. Growth velocity was calculated. Absence of cam deformity signified complete remodelling. Clinical assessment was graded from excellent to poor and patient-reported outcomes were recorded. There was significantly more growth recorded in the un-threaded screw group in femoral neck length (7.6 mm, P = 0.003), articulo-lesser trochanter distance (5.3 mm, P = 0.028), pin-joint ratio (7.439%, P = 0.006) and pin-physis ratio (8.244%, P = 0.001). The probability of revision operations due to ongoing growth was higher in this group (risk ratio: 6.57, P = 0.0008). Time to physeal closure was not significantly different, but growth velocity was significantly higher in the un-threaded group. The lower probability of cam deformity was not significant. Functional and clinical results were not significantly different at average 11.2 years' follow-up. Un-threaded screws allow for significantly more growth than standard threaded screws. The un-threaded screw could not be recommended due to the higher re-operation rates, without any proven benefit.

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“…The potential disadvantages of using these pins or screws include irritation or bursitis from the progressively protruding device, migration of pins, further surgery if the head of the screw abuts the lateral cortex, the need to exchange the device due to overgrowth, and the risk of premature physeal fusion. 15,19,21,24…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Varying techniques, and specifically designed fixation devices, can be used to allow continued proximal femoral growth and remodelling, while preventing further slip (Table I). 15,[17][18][19][20][21][22][23] The potential disadvantages of using these pins or screws include irritation or bursitis from the progressively protruding device, migration of pins, further surgery if the head of the screw abuts the lateral cortex, the need to exchange the device due to overgrowth, and the risk of premature physeal fusion. 15,19,21,24 The Free-Gliding (FG) SCFE screw (Figure 1) (Pega Medical, Canada) 25 was introduced in North America in 2014 and in the UK to the NHS in our trust in 2015.…”

Section: Introductionmentioning

confidence: 99%

“…15,[17][18][19][20][21][22][23] The potential disadvantages of using these pins or screws include irritation or bursitis from the progressively protruding device, migration of pins, further surgery if the head of the screw abuts the lateral cortex, the need to exchange the device due to overgrowth, and the risk of premature physeal fusion. 15,19,21,24 The Free-Gliding (FG) SCFE screw (Figure 1) (Pega Medical, Canada) 25 was introduced in North America in 2014 and in the UK to the NHS in our trust in 2015. It is a two-part self-sliding cannulated screw with threaded fixation both in the epiphysis and the lateral cortex.…”

Section: Introductionmentioning

confidence: 99%

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The Free-Gliding screw for slipped capital femoral epiphysis

Buchan

Lindisfarne

Stabler

et al. 2023

The Bone & Joint Journal

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Aims Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. Methods All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years’ follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein’s line were recorded. Subanalysis was performed according to sex and age. Results A total of 19 hips in 13 patients were included. The mean age of the patients at the time of surgery was 11.5 years (9 to 13) and the mean follow-up was 63 months (45 to 83). A total of 13 FG SCFE screws were used for the fixation of mild or moderate SCFE, with six contralateral prophylactic fixations. No hip with SCFE showed a further slip after fixation and there were no complications. Lengthening occurred in 15 hips (79%), with a mean lengthening of the barrel of 6.8 mm (2.5 to 13.6) at final follow-up. Remodelling occurred in all hips with lengthening of the barrel. There was statistically more lengthening in patients who were aged < 12 years, regardless of sex (p = 0.002). Conclusion The FG SCFE screw is effective in preventing further slip in patients with SCFE. Lengthening of the barrel occurred in most hips, and thus allowed remodelling. This was most marked in younger children, regardless of sex. Based on this study, this device should be considered for use in patients with SCFE aged < 12 years instead of standard pinning in situ. Cite this article: Bone Joint J 2023;105-B(2):215–219.

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Similar femoral growth and deformity with one screw versus two smooth pins for slipped capital femoral epiphysis

Cited by 6 publications

References 25 publications

Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln?

Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln?

Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study

The Free-Gliding screw for slipped capital femoral epiphysis

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