Slipped Capital Femoral Epiphysis

Kumm, D.; Lee, Sunhee; Hackenbroch, M. H.; Rütt, J.

doi:10.1097/00003086-200103000-00023

Cited by 22 publications

(12 citation statements)

References 29 publications

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“…Kumm et al noted that the short thread screws in about one quarter of his patients needed to be replaced with a longer one due to growth [9]. Wong-Chung et al used radiographs to assess remodelling and measured the degree of physeal shaft angle correction [15].…”

Section: Discussionmentioning

confidence: 99%

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Continued growth after fixation of slipped capital femoral epiphysis

Holmdahl

Backteman

Danielsson

et al. 2016

Journal of Children's Orthopaedics

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PurposeWhen treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE.MethodsSixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4–15.7 years), were included. The slipped hip was fixed with a smooth pin with a hook, and the non-slipped hip was prophylactically pinned. At the time of surgery, tantalum markers were installed bilaterally on each side of the growth plate through the drilled hole for the pin. Examination with radiostereometric analysis (RSA) was performed postoperatively and at 3, 6 and 12 months. The position of the epiphysis in relation to the metaphysis was calculated.ResultsAt 12 months, the epiphysis moved caudally, median 0.16 mm and posteriorly 2.28 mm on the slipped side, in comparison to 2.28 cranially and 0.91 mm posteriorly on the non-slipped side, p = 0.003 and p = 0.030, respectively. Both slipped and non-slipped epiphysis moved medially, 1.52 and 1.74 mm, respectively. A marked variation in the movement was noted, especially on the slipped side.ConclusionsThe epiphysis moved in relation to the metaphysis after smooth pin fixation, both on the slipped side and on the prophylactically fixed non-slipped side, implying further growth. The RSA method can be used to understand remodelling after ‘growth-sparing’ fixation of SCFE.

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Section: Discussionmentioning

confidence: 99%

“…In the Scandinavian countries, fixation is achieved with a smooth Hansson pin, which is supplied with a hook device to gain purchase in the epiphysis [8]. In addition, Kumm et al describe a dynamic short thread screw fixation with only threads in the epiphysis, without compression over the growth plate to allow for potential growth [9]. …”

Section: Introductionmentioning

confidence: 99%

Continued growth after fixation of slipped capital femoral epiphysis

Holmdahl

Backteman

Danielsson

et al. 2016

Journal of Children's Orthopaedics

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“…Growth-sparing stabilization using the gliding screw principle or stabilization with stainless non-threaded pins leads to simultaneous fusion of the treated and the healthy contralateral hip, within 31-37 months [3,4,8]. Moreover, the articulotrochanteric distance (ATD: distance of the roof of the femoral head and the tip of the greater trochanter) between the affected and the prophylactically treated hips, is comparable, indicating continuing femoral neck growth after treatment [4].…”

Section: B the Gliding Screw Principlementioning

confidence: 99%

“…Other studies showed that growth-preserving stabilization of the SCFE and the healthy contralateral hip leads to simultaneous physis fusion of both hips (at about 17 months postoperatively). The healthy contralateral hips present more prominent growth, inferring that some injury of the affected growth plate may be permanent, or the slipped physis is primarily deficient [4,8,9].…”

Section: B the Gliding Screw Principlementioning

confidence: 99%

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Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

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Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and earlyonset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.

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