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Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
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The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

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Proximal Femoral Deformity Following Threaded Prophylactic Fixation for Slipped Capital Femoral Epiphysis: Risk

Vedant A Kulkarni¹, Aaron D Boyles¹, Jacob Carl¹

¹Shriners Hospitals for Children-Northern California and UC Davis Medical Center, Sacramento, CA.

Journal of Pediatric Orthopedics

|March 29, 2020

Summary

Skeletally immature patients undergoing prophylactic screw fixation for slipped capital femoral epiphysis (SCFE) face a high risk of developing hip deformities. Growth-friendly fixation methods should be considered to prevent iatrogenic proximal femoral deformity.

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Published on: February 17, 2023

Area of Science:

Orthopedic Surgery
Pediatric Orthopedics
Skeletal Development

Background:

Slipped capital femoral epiphysis (SCFE) is a hip condition affecting adolescents.
Prophylactic screw fixation is sometimes used for the contralateral hip.
Iatrogenic proximal femoral deformity can occur after this procedure.

Purpose of the Study:

To assess the impact of skeletal maturity on iatrogenic proximal femoral deformity after prophylactic screw fixation in unilateral SCFE patients.
To compare outcomes between hips with prophylactic screw fixation and those without.

Main Methods:

Retrospective comparative study of patients with unilateral SCFE.
Two groups: prophylactic screw fixation (Group P) vs. observation (Group N).
Skeletal maturity assessed using Modified Oxford Score (MOS); proximal femoral morphology analyzed.

Main Results:

Group P (n=38) showed diminished neck length and increased trochanteric overgrowth compared to Group N (n=17).
No deformity in Group N; 37% of Group P developed femoral head asphericity (Types 2 & 3).
Skeletally immature patients (MOS 16-17) in Group P had a high incidence of deformity.

Conclusions:

Skeletally immature patients (MOS 16-17) are at high risk for deformity with prophylactic screw fixation for SCFE.
This deformity includes relative trochanteric overgrowth, coxa breva, and femoral head asphericity.
Growth-friendly fixation strategies should be considered to prevent iatrogenic proximal femoral deformity.