Single screw fixation in stable and unstable slipped upper femoral epiphysis

Mulgrew, Emma; Wells-Cole, Simon; Ali, Farhan; Joshy, S.; Siddique, Irfan; Zenios, M.

doi:10.1097/bpb.0b013e328344e76d

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…Age in this study was higher than that being reported from other countries currently, but is similar to that from older studies, and we postulate that we would see an increase in incidence and lowering of age as the lifestyle changes come to our population 69. Boys had a higher incidence than girls, which is similar to the trend reported in the literature probably because the boys are more active and are at risk for a longer period 16…”

Section: Discussionsupporting

confidence: 86%

“…The incidence is higher in young patients with a more acute onset of symptoms 54. The reported rates of incidence vary from 0% in stable slips to as high as 58% in unstable slips 91011. The AVN rate in this series was 7.6%.…”

Section: Discussionmentioning

confidence: 56%

“…The risk of avascular necrosis (AVN) is zero when SUFE is stable, whereas it may be as high as 58% after unstable SUFE 91011. The most accepted treatment for stable slips entails fluoroscopic-guided in situ pinning with a single screw placed centrally in the epiphysis, avoiding any attempt at reduction of the slip 12…”

Section: Introductionmentioning

confidence: 99%

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Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique

Arora

Dutt

Palocaren

et al. 2013

IJOO

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Background:Slipped upper femoral epiphysis (SUFE) is the gradually acquired malalignment of the upper femoral epiphysis (capital) and the proximal femoral metaphysis. SUFE is uncommon in India, and there are no previous studies on outcome and clinical characteristics of patients with SUFE from India. This study evaluates the presentation, disease associations and outcome of SUFE from a tertiary care centre in India.Materials and Methods:Twenty six consecutive children with SUFE seen over a period of 4 years were reviewed. The clinical presentations, severity of the slip, surgical interventions (n=30) were assessed. Twenty one boys and five girls with a mean age 13.1 years (range 10-16 years) were included in the study. Four children had bilateral involvement. There were 4 rural and 22 urban children from the eastern and southern states of the country. The presentation was acute in 7, acute on chronic in 5, and chronic in 14, with a mean duration of symptoms of 51 days (range 3-120 days). Slips were stable in 16 and unstable in 10 children. Two children had adiposogenital syndrome. Body mass index was high in 12 out of 23 children. Vitamin D levels were low in 20 out of 21 children, with a mean vitamin D level of 12.61 ± 5 ng/ml. Eighteen children underwent in situ pinning. Eight children underwent capital realignment.Results:Clinical outcome as assessed by Merle d’ Aubigne score was excellent in 6, good in 10, fair in 6 and poor in 1. Half of the in situ fixation patients underwent osteoplasty procedure for femoroacetabular impingement and 5 more were symptomatic. The head neck offset and α angle after in situ pinning were −1.12 ± 3 mm and 66.05 ± 9.7°, respectively and this improved to 8.7 mm and 49°, respectively, after osteoplasty. One child in the pinning group had chondrolysis. Eight patients with severe slip underwent capital realignment. Mean followup was 20.15 months. The anterior head neck offset and α angle were corrected to 6.8 ± 1.72 mm and 44.6 ± 7.0° mm, respectively. Two children with unstable slip in the capital realignment group had avascular necrosis which was diagnosed at presentation by bone scan.Conclusion:High BMI, vitamin D deficiency and endocrine disorders are associated with SUFE in India and should be evaluated as some of these are amenable to prevention and treatment. Most patients treated with in situ pinning developed femoroacetabular impingement. The early results after capital realignment procedure are encouraging and help to avoid a second procedure which is needed in a majority of patients who underwent in situ pinning.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 56%

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Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique

Arora

Dutt

Palocaren

et al. 2013

IJOO

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“…Slipped capital femoral epiphysis is defined as a posterior and inferior slippage of the proximal femoral epiphysis (1).…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of SPECT/CT in the Detection of Femoral Head Viability in Slipped Capital Femoral Epiphysis

DosSantos

Macalintal

Bouchareb

et al. 2018

J. Nucl. Med. Technol.

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“…Several studies have established the efficacy of in situ fixation using a single screw (Carney et al, 2003). Use of a single screw can also be considered in unstable SCFE, although the risk of material breakage is higher (Mulgrew et al, 2011). Post operatively, X-ray is taken (Figure 6) for evaluation.…”

Section: Figure 1 Supine On Fracture Table Gentle Transfer No Reductionmentioning

confidence: 99%

To Pin a SCFE One Screw is Preferred than Two Screws in Children

Nefihancoro

2020

INDONES J MED

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Background: Slipped capital femoral epiphysis (SCFE) is one of the most frequent hip disorders in children. SCFE is due to the displacement of the epiphysis (femoral head that keeps its location in the acetabulum) relative to the metaphysis (femoral neck) and shaft at the physic level. Treatment seeks to prevent worsening of epiphyseal slippage on the metaphysis, and percutaneous in situ fixation (ISF) using a single cannulated screw has long shown efficacy. Case Presentation: An 11 years old boy presented with diagnosed with slipped capital femoral epiphysiolysis of right hip and treated operatively with one screw pinning guiding fluoroscopy. Post operatively, from X-Ray evaluation confirmed the proper position without joint penetration. Patient is then advised to walk with crutches for gradual weight bearing to full weight bearing after 4 weeks. Then after 6 weeks, patient had already walked normally again. Conclusion:In unstable moderate-to-severe SCFE, the best reduction indications and technique remain controversial. There are many theories supporting one or two screws pinning technique. In this case we used one screw pinning fixation with excellent result.

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Single screw fixation in stable and unstable slipped upper femoral epiphysis

Cited by 12 publications

References 17 publications

Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique

Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique

Incremental Value of SPECT/CT in the Detection of Femoral Head Viability in Slipped Capital Femoral Epiphysis

To Pin a SCFE One Screw is Preferred than Two Screws in Children

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