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

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

doi:10.1097/00004694-200309000-00004

Cited by 28 publications

(24 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Carney et al (2003) found that 20% suffered a slip progression of 10° or more when operated with a single cannulated screw. The idea that double screw fixation is more likely to provide torsional stability in non-reduced slips than a single screw has been verified in artificially created slips in bovine femurs (Segal et al 2006).…”

Section: Discussionmentioning

confidence: 99%

“…Chondrolysis was defined as more than 50% reduction of minimal joint space compared to the contralateral side (Loder et al 2000). Slip progression was defined as an increased lateral epiphyseal shaft angle by more than 10° from surgery to final follow-up at skeletal maturity (Carney et al 2003). In accordance with Jerre, we considered a lateral epiphyseal-shaft angle above 13° in the asymptomatic, contralateral hip to be diagnostic of a silent slip (Loder et al 1993, Jerre et al 1994).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Lehmann¹,

Engesæter²,

Laborie³

et al. 2011

Acta Orthopaedica

View full text Add to dashboard Cite

Background and purposeSlipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins.Patients and methodsAll 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis.Results67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis.InterpretationIn situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Lehmann¹,

Engesæter²,

Laborie³

et al. 2011

Acta Orthopaedica

View full text Add to dashboard Cite

show abstract

“…With the epiphysis being small, only a limited number of screw threads would engage the femoral head epiphysis. Carney et al showed progressive slippage in patients with slipped capital femoral epiphysis when less than five threads engaged the proximal femoral epiphysis [ 22 ]. This group of patients requiring revision of the transphyseal screw to recapture the proximal femoral physis still made improvements in head–shaft angle and physeal orientation.…”

Section: Discussionmentioning

confidence: 99%

Caput valgum associated with developmental dysplasia of the hip: Management by transphyseal screw fixation

Torode

Young

2015

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

PurposeA late finding of some hips treated for developmental dysplasia of the hip (DDH) is a growth disturbance of the lateral proximal femoral physis, which results in caput valgum and possibly osteoarthritis. Current treatment options include complete epiphysiodesis of the proximal femoral physis or a corrective proximal femoral osteotomy. Alternatively, a transphyseal screw through the inferomedial proximal femoral physis that preserves superolateral growth might improve this deformity.MethodsThis study evaluates the effect of such a transphyseal screw on both femoral and acetabular development in patients with caput valgum following open treatment of DDH. These patients were followed clinically and radiographically until skeletal maturity. Preoperative and postoperative radiographs were assessed, measuring the proximal femoral physeal orientation (PFPO), the head–shaft angle (HSA), Sharp’s angle and the center edge angle of Wiberg (CE angle).ResultsThirteen hips of 11 consecutive patients were followed prospectively. The age at the time of transphyseal screw placement was between 5 and 14 years. The mean improvement of the PFPO and HSA was 14° (p < 0.01) and 11° (p < 0.001), respectively. The mean improvement of Sharp’s angle and CE angle was 4.7° (p < 0.01) and 5.8° (p < 0.02), respectively. Five patients underwent screw revision.ConclusionsA transphyseal screw across the proximal femoral physis improved the proximal femur and acetabular geometry.

show abstract

“…Upasani et al reported that maximum stability was gained when 40%-60% of the threads engaged the epiphysis using a 16 mm-thread single screw [ 18 ]. Carney et al recommended that five or more threads should engage the epiphysis [ 24 ]. In our study, the distribution of the threads was not a prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Lateral insertion is a good prognostic factor after in situ fixation in slipped capital femoral epiphysis

Hagiwara

Nakamura

Kamegaya

et al. 2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundIn situ fixation (ISF) is standard treatment for slipped capital femoral epiphysis (SCFE) to stabilize the epiphysis and to prevent further slip. The aim of this study was to clarify the incidence of slip progression after ISF and its prognostic factors.MethodsWe retrospectively reviewed 53 hips in 49 consecutive SCFE patients who underwent single screw ISF and were followed until physeal closure. Clinical and radiographic findings were viewed to assess progression of the posterior tilting angle (PTA).ResultsMean PTA was 33.4 degrees (range, 18 to 75 degrees) at ISF and 35.9 degrees (range, 18 to 75 degrees) at physeal closure with progression of PTA of 2.5 degrees (range, -2 to 19 degrees). Slip progression occurred in 28 of 53 hips (53%), and more than five degrees of progression occurred in 14 hips (26%). Multiple regression analysis revealed that point of screw insertion (one point for lateral and two points for medial) was a significant prognostic factor for progression of the slip by the following formula: (progression of PTA) = -1.523 + 2.701 × (point of screw insertion), R2 = 0.148, p = 0.005.ConclusionsThe current study showed that a screw inserted from the lateral side to the intertrochanteric line prevented postoperative slip progression.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-317) contains supplementary material, which is available to authorized users.

show abstract

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

Cited by 28 publications

References 19 publications

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Caput valgum associated with developmental dysplasia of the hip: Management by transphyseal screw fixation

Lateral insertion is a good prognostic factor after in situ fixation in slipped capital femoral epiphysis

Contact Info

Product

Resources

About