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Slipped capital femoral epiphysis. A prospective study of fixation with a single screw
1Department of Orthopaedic Surgery, Children's Hospital of Michigan, Detroit.
Insights
In situ pinning with a single screw effectively treated slipped capital femoral epiphysis in children, with most hips achieving excellent or good outcomes. This surgical technique demonstrated a low complication rate, making it a viable treatment option.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Skeletal research
Background:
- Slipped capital femoral epiphysis (SCFE) is a hip condition affecting adolescents.
- In situ pinning is a common surgical management for SCFE.
- Long-term outcomes and complications of this technique require ongoing evaluation.
Purpose of the Study:
- To evaluate the efficacy and safety of in situ pinning using a single cannulated screw for pediatric SCFE.
- To assess clinical and radiographic outcomes in a cohort of children treated with this method.
- To identify the incidence of complications such as avascular necrosis and chondrolysis.
Main Methods:
- Retrospective review of 44 children (58 hips) with SCFE treated between 1983 and the study period.
- In situ pinning with a single cannulated screw was the primary surgical intervention.
- Patients were followed for an average of 3 years, with outcomes assessed using established clinical and radiographic criteria.
Main Results:
- 54 out of 58 hips (93%) achieved excellent or good outcomes based on Heyman and Herndon criteria.
- Avascular necrosis occurred in one patient with an acute slip; chondrolysis was not observed.
- Complications included one subtrochanteric fracture and two cases of increased slippage.
Conclusions:
- In situ pinning with a single cannulated screw is a safe and effective treatment for slipped capital femoral epiphysis in children.
- The procedure yields a high rate of satisfactory clinical and radiographic results.
- This technique is associated with a low risk of major complications like avascular necrosis and chondrolysis.
Abstract:
Forty-four children (fifty-eight hips) who had a slipped capital femoral epiphysis were managed by in situ pinning with a single cannulated screw. This method of treatment was first used in our institution in 1983. Thirty-one boys and thirteen girls were followed for an average of three years (range, two to six years). There were eight acute slips and fifty chronic slips. Thirty-four patients were black and ten patients were white. The clinical criteria of Heyman and Herndon and the radiographic parameters cited by Boyer et al. were used to grade the results. Fifty-four hips were rated as either excellent or good. Avascular necrosis developed in one patient who had an acute slipped capital femoral epiphysis, but chondrolysis did not occur in any patient. The complications included a subtrochanteric fracture in one patient and an increase in the degree of slippage of the capital femoral epiphysis in two patients.