The metaphyseal fossa surrounding the epiphyseal tubercle is larger in hips with moderate and severe slipped capital femoral epiphysis than normal hips

Abstract

Purpose To compare the 3D morphology of the metaphyseal fossa among mild, moderate and severe stable slipped capital femoral epiphysis (SCFE) and normal hips. Methods We identified pelvic CT of 51 patients (55% male; mean 12.7 years (sd 1.9; 8-15)) with stable SCFE. In all, 16 of 51 hips (31%) had mild, 14 (27%) moderate and 21 (41%) severe SCFE. A total of 80 patients (50% male; mean age 11.5 years (sd 2.3; 8 to 15)) with normal hips who underwent pelvic CT due to abdominal pain made up the control cohort. CT scans were segmented, and the femur was reformatted using 3D software. We measured the metaphyseal fossa depth, width, length and surface area after the epiphysis was subtracted from the metaphysis in the 3D model. Results The metaphyseal fossa width was significantly larger in severe (adjusted difference: 6.9%; 95% confidence interval (CI) 2.1 to 11.8; p = 0.001), moderate (6.5%; 95% CI 0.8 to 12.2; p = 0.02) and mild SCFE (6.2%; 95% CI 0.8 to 11.6; p = 0.01), in comparison with normal hips. Severe SCFE showed larger fossa length compared with mild SCFE (6.8%; 95% CI 0.6 to 13.0; p = 0.02) and normal hips (6.0%; 95% CI 1.4 to 10.6; p = 0.004). The fossa surface area was larger in severe (3.5%; 95% CI 1.3 to 5.7; p < 0.001) and moderate SCFE (2.7%; 95% CI 0.1 to 5.2; p = 0.03) when compared with normal hips. There were no differences in fossa depth between SCFE and normal hips. Conclusion The metaphyseal fossa is wider and more extensive but not deeper in hips with moderate and severe SCFE in comparison with normal hips. Although hips with severe SCFE had larger length and surface area than mild SCFE hips, further research is needed to clarify whether enlargement of the metaphyseal fossa is a consequence of slip progression. Level of Evidence III

Smaller epiphyseal tubercle in hips with slipped capital femoral epiphysis compared to the uninvolved contralateral hip

“…However, a previous study showed that the metaphyseal fossa is larger in hips with moderate and severe SCFE than normal hips. 19 The discrepancy of our findings may be due to the proportion of severe (41%) and moderate (27%) SCFE in the previous study while our cohort had too few severe cases. Similarly, we saw smaller fossa length, compared to the contralateral uninvolved hip, in acute SCFE cases while there was no side-to-side difference in chronic SCFE cases.…”

“…10,14,18 Several previous studies have described SCFE as a rotational deformity and highlighted the role of the epiphyseal tubercle in the pathogenesis of SCFE. 11,[15][16][17]19 Furthermore, research utilizing computed tomography (CT) has reported that the epiphyseal tubercle is smaller, while the metaphyseal fossa and the peripheral cupping are larger in hips with severe SCFE compared to healthy control hips. 13,19 Nevertheless, CT examinations are limited to the assessment of the bony margins of the epiphysis and metaphysis and are not the ideal modality for investigating the changes to the growth plate, which is a cartilaginous structure.…”

“…11,[15][16][17]19 Furthermore, research utilizing computed tomography (CT) has reported that the epiphyseal tubercle is smaller, while the metaphyseal fossa and the peripheral cupping are larger in hips with severe SCFE compared to healthy control hips. 13,19 Nevertheless, CT examinations are limited to the assessment of the bony margins of the epiphysis and metaphysis and are not the ideal modality for investigating the changes to the growth plate, which is a cartilaginous structure. In contrast, magnetic resonance imaging (MRI) can provide an enhanced visualization of the growth plate, including the epiphyseal tubercle and metaphyseal fossa in hips with SCFE.…”

Roadmap for an imaging and modelling paediatric study in rural NZ

“…As the limbs of the typically developing (TD) child grow, there is a programmed modelling of the long bones with systematic changes in length, width, and version (Herring and Tachdjian, 2020). Atypical development, such as children suffering from cerebral palsy or slipped capital femoral epiphysis (SCFE), can lead to delayed or altered skeletal modelling with consequent effects on hip stability, gait pattern and limb alignment (Gage et al, 2009;Hosseinzadeh et al, 2020). Understanding morphological variation in the typically developed skeleton is important to diagnose and treat morphological variations and pathology.…”

On the Role of the Reserve Zone and Mechano-Regulatory Stimuli in the Development and Maturation of the Growth Plate: Observations and Models

“…It is conceivable that deficiencies in the development of the subchondral bone plate and mammillary processes may result in weakening of the interface and could contribute to conditions such as slipped capital femoral epiphysis (SCFE). SCFE is characterized by a non-traumatic displacement of the femoral metaphysis with respect to the capital femoral epiphysis through failure of the physis and is believed to have a multifactorial etiology involving biomechanical, biochemical, endocrine and developmental factors [5,6,7,8,9].…”