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

Snyder, Ryan R; Williams, John L.; Schmidt, Thomas L.; Salsbury, Thomas

doi:10.1097/01.bpo.0000214906.70045.78

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…Kishan et al 50 additionally created similar simulated 'unstable' slips utilizing porcine models and compared the biomechanical properties of single versus double screw fixation. This study validated similar results to previous studies, 48,49 finding that double screw fixation led to significantly greater average stiffness. However, they additionally found no significant difference in the average maximum load used to create failure at the physis when comparing single and double screw fixation.…”

Section: Single Vs Two Screw Fixationsupporting

confidence: 92%

“…Snyder et al 49 aimed to recreate 'unstable' slips in a porcine model and assess the relative torsional strength of the models with single or double screw fixation. This study found that double screw fixation yielded nearly double the torsional strength and stiffness as a single screw fixation in 'unstable' SCFE.…”

Section: Single Vs Two Screw Fixationmentioning

confidence: 99%

“…The consensus in the literature indicates that the use of two screws in SCFE fixation should be reserved for unstable or severe slips. [49][50][51][52] The routine usage of two screws in treatment of stable or mild to moderate SCFE is not recommended. 49,51 Numerous complications associated with double screw fixation have been reported, including increased possibility of one or more screws extending into the joint space, increased risk of avascular necrosis due to increased chance for disruption of blood vessels, and increased risk of chondrolysis.…”

Section: Single Vs Two Screw Fixationmentioning

confidence: 99%

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The Etiology and Management of Slipped Capital Femoral Epiphysis

Haider¹,

Podeszwa²,

Morris³

2022

Journal of the Pediatric Orthopaedic Society of North America

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We review insights into slipped capital femoral epiphysis (SCFE) gained during the last decade and updates to current management practices. Anatomic and clinical studies recently demonstrate that the epiphysis rotates around an epiphyseal tubercle during displacement. Clinical endocrinopathies contribute to the pathogenesis of SCFE, and recently the effects of subclinical endocrine derangements have been demonstrated to play a role in SCFE. Patients with positive age-weight or age-height testing are recommended to undergo further endocrine workup due to the high likelihood of atypical SCFE in these patients. In situ pinning with two screws is mainly reserved for unstable or severe slips, while one-screw fixation remains the standard for mild-moderate slips. Contralateral prophylactic pinning is typically considered in those patients with an atypical slip, relative skeletal immaturity, or aberrant radiographic parameters such as posterior epiphyseal tilt or sloping angle. Novel intraoperative epiphyseal perfusion monitoring has provided insight into reducing complications such as avascular necrosis and has shown the benefit of intracapsular hematoma decompression for unstable SCFE. Open surgical management via the modified Dunn procedure should be cautiously considered, as high rates of osteonecrosis have been reported due to the vulnerable blood supply of the proximal femoral head. Key Concepts• The epiphyseal tubercle acts as a prominent stabilizer of the proximal femoral epiphysis and pivot point for a posterior rotation and displacement of the epiphysis during SCFE.• Hyperinsulinism and increased leptin concentrations lead to biochemical alterations of the proximal femoral physis that contribute to physeal failure.• Further endocrine and metabolic workup is needed for patients with a positive age-weight or age-height test due to the high likelihood of atypical SCFE.

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Section: Single Vs Two Screw Fixationsupporting

confidence: 92%

Section: Single Vs Two Screw Fixationmentioning

confidence: 99%

Section: Single Vs Two Screw Fixationmentioning

confidence: 99%

See 1 more Smart Citation

The Etiology and Management of Slipped Capital Femoral Epiphysis

Haider¹,

Podeszwa²,

Morris³

2022

Journal of the Pediatric Orthopaedic Society of North America

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“…Authors have hypothesized that, with increasing numbers of pins and screws, these risks may increase as the opportunity for intra-articular pin penetration and incorrect location of the pin within the epiphysis increases with each inserted pin. These risks must be balanced against the benefits demonstrated in animal model biomechanical studies 46,47 that show that multiple pins provide a stronger construct, which may be particularly important in severe slips that are intrinsically less stable and may require multiple points of fixation.…”

Section: Number Of Pinsmentioning

confidence: 99%

Strategies to Avoid Osteonecrosis in Unstable Slipped Capital Femoral Epiphysis

Daley

Zaltz

2019

JBJS Rev

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Osteonecrosis of the femoral epiphysis following slipped capital femoral epiphysis (SCFE) causes substantial patient morbidity.» The etiology of osteonecrosis following SCFE is multifactorial, and multiple treatment strategies, including techniques of epiphyseal reduction, capsulotomy, and timing of surgical intervention, that are intended to reduce this risk have been utilized. » At the present time, because of conflicting data and the lack of high-level evidence, there are a paucity of data to determine the role that these techniques play in reducing the risk of osteonecrosis.» Further scientific research is needed to understand the etiology of osteonecrosis following SCFE. Slipped capital femoral epiphysis (SCFE) is a disorder of the immature proximal femoral physis that can lead to substantial patient morbidity and long-term sequelae. The long-term consequences of SCFE include femoroacetabular impingement secondary to proximal femoral deformity, chondrolysis, slip progression, and osteoarthritis. The most devastating early complication is osteonecrosis of the femoral head that may cause early deterioration of the hip 1 . Because the etiology of osteonecrosis following SCFE is likely multifactorial and remains incompletely understood, a variety of surgical techniques have been utilized to attempt to alter this sequela. Historical treatment options, including spica casting and open physiodesis, were largely abandoned by the 1950s, when the modern technique of in situ pinning was described. Currently, there remains controversy with regard to the timing of intervention, the role of capsulotomy with hematoma evacuation 2 , and closed reduction [2][3][4] . The type of surgical intervention chosen and the surgeon's technique may have a substantial impact on the patient's outcome and likelihood of complications. The treatment paradigm became more complex in 2009 when Ziebarth et al. 5 published the first outcomes of the modified Dunn proximal femoral capital realignment technique utilizing a surgical hip dislocation approach. However, in the current era, recognizing the potential for iatrogenic complications 6 , the indications for this open reduction technique remain a topic of debate, with authors suggesting a role for patients with radiographically severe slips 7 , as well as those with acute, unstable slips 8 .Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSREV/A439).

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“…The femur of the 1‐year‐old sus scrofa domesticus (domestic pig) has been shown to have comparable dimensions and biomechanical properties to that of the adolescent human counterpart (Chung, et al, 1976) and has served well as a model for mechanical testing and fixation device studies (Chuinard, Williams, et al, 2004; Galligan, Williams, et al, 2004; Ipsen et al, 2002; Jónasson, Ekström, et al, 2014; Jónasson, Ekström, et al, 2015; Snyder, Williams, et al, 2006). Along with gross anatomical and physiological similarities, the domestic pig is also subject to the hip disorder SCFE (Jubb, Kennedy, & Palmer, 1985).…”

Section: Introductionmentioning

confidence: 99%

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

Perrone

Williams

2021

The Anatomical Record

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The capital femoral physis is a growth plate located between the head of the femur and femoral neck, which forms a temporary joint where growth plate cartilage is converted to bone by endochondral ossification. The bone‐cartilage‐bone interface develops a unique radial pattern of interdigitating mammillary processes that interlock the femoral head with the metaphysis, increasing biomechanical stability. The arrangement of these mammillary processes may not be a random occurrence and likely serves to provide mechanical mechanisms to enhance biomechanical stability. In this study, we provide a qualitative and quantitative analysis of porcine femoral head mammillary processes and focus on the analysis of six key points of development: the epiphyseal tubercle, epiphyseal cupping, growth plate slope angles, expansion of the epiphyseal subchondral bone plate, epiphyseal elongation, and the emergence of smaller, radially arranged mammillary processes. We introduce a metric of surface roughness analysis to quantify mammillary processes and apply it to analyze the development of the observed radial pattern of peripheral mammillary processes from birth to adolescence. We hypothesized that these processes develop to form a radial pattern with some degree of periodicity beginning relatively early in development of the joint and increase in prominence with age and weight of the animal. These findings may have important implications in the early diagnosis and treatment of the hip disorder slipped capital femoral epiphysis (SCFE). Underdevelopment of femoral head mammillary processes may reduce joint stability and could be a risk factor in SCFE.

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

Cited by 10 publications

References 22 publications

The Etiology and Management of Slipped Capital Femoral Epiphysis

The Etiology and Management of Slipped Capital Femoral Epiphysis

Strategies to Avoid Osteonecrosis in Unstable Slipped Capital Femoral Epiphysis

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

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