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Slipped capital femoral epiphysis. The case for internal fixation in situ
D D Aronson1, D A Peterson, D V Miller
1Department of Orthopaedic Surgery, Children's Hospital of Michigan, Detroit.
Insights
In situ pinning for slipped capital femoral epiphysis can lead to complications. This study found poor pin placement, not race, correlated with adverse outcomes like chondrolysis.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- In situ pinning is a common treatment for slipped capital femoral epiphysis (SCFE).
- Chondrolysis, a serious complication, has been linked to unrecognized pin penetration into the hip joint.
- Previous research suggested Black children may have a higher risk of chondrolysis after SCFE treatment.
Purpose of the Study:
- To evaluate the long-term clinical and radiographic outcomes of in situ pinning for SCFE.
- To investigate the correlation between pin position and complications such as chondrolysis and avascular necrosis.
- To determine if Black children are more susceptible to chondrolysis after in situ pinning for SCFE.
Main Methods:
- A retrospective review of 55 children (80 SCFE hips) treated with in situ pinning.
- Patients were evaluated at an average of 3.3 years post-operatively using clinical and radiographic parameters.
- Complications including chondrolysis and avascular necrosis were recorded and correlated with pin placement and patient demographics.
Main Results:
- Overall, 70% of treated slips had excellent or good outcomes.
- Success rates varied by slip severity: 86% for mild, 55% for moderate, and 27% for severe.
- Chondrolysis occurred in 4% and avascular necrosis in 3% of cases. Poor pin positioning was associated with complications and poor results.
- Contrary to prior beliefs, this study found no increased susceptibility to chondrolysis in Black children.
Conclusions:
- In situ pinning can achieve good to excellent results for slipped capital femoral epiphysis, particularly in mild cases.
- Poor pin placement, often due to technical challenges with the lateral approach, is a significant risk factor for complications.
- Race was not found to be a predisposing factor for chondrolysis in this cohort of pediatric patients treated for SCFE.
Abstract:
The traditional method of treating slipped capital femoral epiphysis by in situ pinning is being challenged. The complication of chondrolysis has been correlated with unrecognized pin penetration into the hip joint. Several studies have shown that black children may be more susceptible to developing chondrolysis. Fifty-five children (89% black) with 80 slipped epiphyses agreed to return for evaluation by the authors at an average of 3.3 years after in situ pinning. The results were classified according to clinical and roentgenographic parameters. The results were excellent or good in 56 (70%) of the 80 slips. Excellent or good results were found in 86% of mild slips, 55% of moderate, and 27% of severe. The complication of chondrolysis developed in three slips (4%) and avascular necrosis in two (3%). Poor pin position could be correlated with the complication in one of the three patients who developed chondrolysis and in both who developed avascular necrosis. Poor pin position was also associated with 12 (60%) of the 20 poor results. The majority of pin problems were secondary to technical problems associated with attempting in situ pinning from the lateral approach. In this study, black children were not more susceptible to chondrolysis than nonblack children.