Slip Progression After In Situ Single Screw Fixation for Stable Slipped Capital Femoral Epiphysis

Carney, Brian T.; Birnbaum, Peter; Minter, Christin

doi:10.1097/01241398-200309000-00004

Cited by 61 publications

(11 citation statements)

References 21 publications

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“…25,26 It appears that progression of the slip may occur more frequently if fewer than 5 screw threads cross into the epiphysis. 27 An eccentrically placed screw increases vulnerability to rotational displacement. Most of the concern with using 2 screws focuses on the risk of penetration of the femoral head by the screws because the risk of penetration increases as the number of pins or screws increases.…”

Section: Discussionmentioning

confidence: 99%

Torsional Strength of Double- Versus Single-screw Fixation in a Pig Model of Unstable Slipped Capital Femoral Epiphysis

Snyder

Williams

Schmidt

et al. 2006

Journal of Pediatric Orthopaedics

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Slipped capital femoral epiphysis was produced in 9 matched pairs of fresh-frozen pig femurs (1-year-old pigs) by twisting the femoral head about the femoral neck axis. Each matched pair was fixed with a single steel cannulated screw on one side and 2 screws contralaterally, after which the perichondrium was removed before retesting. Double-screw fixation without the perichondrium provided 43% of the stiffness and 74% of the strength of the intact physis in torsion and approximately double the stiffness and strength of single-screw fixation (P<0.004). This information may be of use to the surgeon concerned about rotational stability in unstable slipped capital femoral epiphysis.

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Section: Discussionmentioning

confidence: 99%

Torsional Strength of Double- Versus Single-screw Fixation in a Pig Model of Unstable Slipped Capital Femoral Epiphysis

Snyder

Williams

Schmidt

et al. 2006

Journal of Pediatric Orthopaedics

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“…Carney et al [32] in their series reported that slip progression is inversely related to the number of screw threads engaging the epiphysis on the postoperative radiograph. This finding was not reproduced in our study; possibly because all of the patients in our series had at least 8 mm of threads engaging the epiphyses.…”

Section: Discussionmentioning

confidence: 99%

Screw placement in slipped upper femoral epiphysis: Is good the enemy of better?

Jamil

Allami

Varghese

et al. 2007

Journal of Children's Orthopaedics

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Introduction and aims A single hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours the placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes to avoid the risks of chondrolysis and avascular necrosis (AVN). We investigated the correlation between different positions of the screw in the femoral head and the prevalence of AVN, chondrolysis, late slippage and the time to epiphyseal closure.Methods The clinical notes and radiographs of 38 consecutive patients (61 hips) who underwent single screw fixation for SUFE were evaluated retrospectively with a mean follow-up of 36 months. Two-way ANOVA and the post hoc test was performed to analyse the correlation between the different variables and the outcome at the 5% level of significance.Results There were 16 acute slips, 18 chronic slips and ten acute-on-chronic slips. Seventeen slips were treated prophylactically. Mild slip was encountered in 39 hips, moderate slip in four and severe slip in one. The centralcentral position was only achieved in 51% of cases. The most significant results of the study were as follows: (1) no significant difference between the time to epiphyseal closure and the position of the screw, and (2) no late slippage or chondrolysis was observed in our series.Conclusion Our results showed that the positioning of the screw other than in the centre of the femoral head has the ability to provide physeal stability and has no correlation with the timing to closure of the epiphysis and the risk of avascular necrosis or chondrolysis. We therefore recommend that other positions be considered if the ''optimal central-central position'' is not initially achieved -specifically for the treatment of mild slip -as the potential hazards from several attempts to achieve the optimum position outweigh the benefits.

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“…Carney, et al reported a progression rate of 20% in 46 hips which were treated with in situ single cannulated screw fixation. All hips that deteriorated had less than 5 screw threads engaging the epiphyseal line on postoperative radiographs (5) . A biomechanical study using 7.3 mm stainlesssteel AO screw (5 threads) by Upasani, et al (6) reported that femurs with 2 or 3 threads across the physis had a greater load to failure and stiffness compared to femurs with 1, 4 or 5 threads across the pysis.…”

Section: Discussionmentioning

confidence: 99%

Does the number of engaged screw threads affect the stability of slipped capital femoral epiphysis insitu fixation?

Günay¹,

Küçük²,

Sözbilen³

et al. 2017

BUCH

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Objective: The management of slipped capital femoral epiphysis (SCFE) frequently seen in obese adolescents is fixation with cannulated screw. In this study, it was aimed to evaluate the relationship between the stability of the physis and the number of screw threads passing across the physeal line in the treatment of slipped capital femoral epiphysis (SCFE) with single screw fixation. Methods: Thirty-three hips of 25 SCFE patients who had undergone in situ fixation with cannulated screw were included in the study. The mean age and follow up were 12.33 years (range, 7-16) and 42.24±16.65 months, respectively. The hips were grouped regarding to chronicity; acute, acute on chronic and chronic slips. The patients were also regrouped regarding the stability of the slip. Pre-and postoperatively both antero-posterior and frog leg pelvis radiographies were evaluated to measure Southwick slip angles and the number of screw threads. Results: Metabolic or endocrinologic pathologies were observed in 13 patients. During the follow up four hips were reoperated due to the insufficiency of the screw threads passing across the physeal line. The mean number of the screw threads was 1,85 (range, 0-3) for the revised hips and 3.87 (range, 2-5) for the rest. The mean slip angle was 37.88°±15.2° preoperatively. Postoperatively, the angle was reduced to 29.00°±16.41° (p=0.0001). Postoperative slip angles were significantly different between chronicity groups (p=0.019). In the acute slip group, mean slip angle was 21.00°±11.08° whereas in the chronic group it was 42.22°±17.98° (p=0.009). Conclusion: It was concluded that in the surgical treatment of SCFE with a single screw, the number of screw threads passing across the epiphyseal line should be at least four; otherwise fixation would not be stable enough.Key words: Slipped capital femoral epiphysis, adolescent obesity, in-situ fixation, screw threads ÖZ Amaç: Adölesanlarda obezite ile birlikte sık görülen bir hastalık olan femur başı epifiz kaymasının (FBEK) tedavisi kanüllü vida ile in-situ tespittir. Bu çalışmada, tek kanüllü vida ile tedavi edilen FBEK'lerde epifizi geçen yiv sayısı ile stabilitenin ilişkisini saptamak amaçlanmıştır. Yöntem: 2008-2013 yılları arasında kanüllü vida ile opere olan 25 FBEK hastasının 33 kalçası pre op ve post op olarak klinik ve radyolojik olarak değerlendirildi. Kalçalar etiyolojisine göre akut, kronik zeminde akut ve kronik olmak üzere gruplandırılırken, stabilite açısında gruplandırıldılar. Radyolojik olarak kalça tam AP ve frog-leg pozisyonlarında, operasyon öncesi ve sonrası Southwick açıları (epifiz-diafiz açısı), operasyon sonrası epifiz hattını geçen yiv sayıları ölçüldü. Bulgular: On üç olguda metabolik veya endokrinolojik patoloji gözlendi. Tek kanüllü vida kullanılarak opere edilen olguların 4'ünde cerrahi sonrasında kayma açılarında artış olduğu göz-lendi ve revize edildi. Bu 4 kalçada ön-arka ve frog-leg pozisyonlardaki grafilerde değerlendiri-len epifiz hattını geçen yiv sayısı ortalaması 1.85 idi. Kayma açısında artış olmayan 2...

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Slip Progression After In Situ Single Screw Fixation for Stable Slipped Capital Femoral Epiphysis

Cited by 61 publications

References 21 publications

Torsional Strength of Double- Versus Single-screw Fixation in a Pig Model of Unstable Slipped Capital Femoral Epiphysis

Torsional Strength of Double- Versus Single-screw Fixation in a Pig Model of Unstable Slipped Capital Femoral Epiphysis

Screw placement in slipped upper femoral epiphysis: Is good the enemy of better?

Does the number of engaged screw threads affect the stability of slipped capital femoral epiphysis insitu fixation?

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