Vascular Supply to Slipped Capital Femoral Epiphysis

Maeda, Shingo; Kita, Atsushi; Funayama, Kanichi; Kokubun, S.

doi:10.1097/01241398-200109000-00021

Cited by 55 publications

(31 citation statements)

References 20 publications

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“…Maeda et al performed selective angiography of the medial circumflex femoral artery in children with SCFE to examine whether the vascular supply is damaged before reduction of the slip [24]. With correspondence to previous MRI studies in children with Legg-Calve-Perthes disease [25][26][27], MRI was very effective in demonstrating the femoral head vascularization in children with SCFE in our study.…”

Section: Discussionsupporting

confidence: 51%

Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results

et al. 2006

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In this study we used contrast-enhanced magnetic resonance imaging (MRI) to evaluate the vascularization of the femoral head in children with slipped capital femoral epiphysis (SCFE) before and after cannulated screw fixation. Eleven consecutive children with SCFE, seven boys and four girls, aged 10-15 years were included in the study. There were no preslips; four children had acute, three acute-on-chronic, and four chronic SCFE. The MRI examinations were performed in a 1.5 Tesla MR scanner with use of a coronal STIR sequence, a coronal contrast-enhanced T1-weighted spin-echo sequence, and a sagittal three-dimensional gradient-echo sequence. Morphology, signal intensities, and contrast-enhancement of the femoral head were assessed by two radiologists in consensus. Morphologic distortion of the physis, bone marrow edema within the metaphysis and epiphysis, and joint effusion were the preoperative MRI findings of SCFE in each child. In nine children, the vascularization of the femoral head before and after surgery was normal. In one child, a preoperative avascular zone in the superolateral aspect of the epiphysis revascularized completely after surgery. One child with severe SCFE developed avascular necrosis of the femoral head after open reduction of the slip. We conclude that MRI allows for accurate evaluation of the femoral head vascularization before and after surgery in children with SCFE.

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Section: Discussionsupporting

confidence: 51%

Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results

et al. 2006

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“…In all, there were 43 boys and 39 girls (52/48%). The mean age for boys was 12.5 years (range, 7-15) and the mean age for girls 12.0 years (range, [7][8][9][10][11][12][13][14]. The characteristics of the patients with and without unstable slips are given in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Does unstable slipped capital femoral epiphysis require urgent stabilization?

Kalogrianitis

Tan

Kemp

et al. 2007

Journal of Pediatric Orthopaedics B

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Controversy exists regarding the role of early reduction and stabilization in the management of unstable slipped capital femoral epiphysis. It seems logical that early reduction and stabilization of an unstable slip might preserve the remaining blood supply to the epiphysis and reduce the incidence of avascular necrosis. Some studies have indeed shown lower rates of avascular necrosis following early reduction and stabilization, but others have shown the contrary. To try to resolve this disagreement, we conducted a retrospective review of slipped capital femoral epiphysis treated in Alder Hey Hospital over a 4-year period. We reviewed 117 consecutive slips in 82 children (43 boys and 39 girls, mean age 12 years), treated by internal fixation from 1998 to 2002. Mean follow-up was 18 months (range, 12-48 months). Sixteen cases (19%) were unstable at presentation. Avascular necrosis developed in eight of these, of which all but one were treated between 24 and 72 h after symptom onset. The eight unstable slips that did not develop avascular necrosis were treated either within 24 h (five children) or at 8 days (three children). Avascular necrosis did not develop in any of the stable slips. We recommend immediate stabilization of unstable slips presenting within 24 h. If this is not possible because of delayed presentation, we recommend deferring definitive management until at least a week has elapsed. This study supports the notion that there is a definite period of time during which medical intervention increases the risk of avascular necrosis and should be actively avoided. We term this period 'the unsafe window'.

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“…25e28 Reduction and pins have been blamed for being responsible of vascular injury but the vascular injury appears for numerous authors to be present before surgery. 6,7,16,29 Maeda et al 27 showed with super selective angiography of the medial circumflex femoral artery that three of five unstable hips had a vascular injury before surgery. One of these unstable hips had an angiography after reduction, which showed that vascular supply recovered.…”

Section: Discussionmentioning

confidence: 99%