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Treatment Outcomes at Skeletal Maturity After Physeal-sparing Procedures for Early-onset Slipped Capital Femoral
Kwang Ryeol Lee1, Whei Jun Kim1,2, Wonik Lee1
1Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine.
Background:
Physeal-sparing procedures are preferred for treating early-onset slipped capital femoral epiphysis (SCFE), reducing limb-length discrepancy (LLD), and femoroacetabular impingement (FAI). This study aimed to investigate the treatment outcomes after physeal-sparing procedures for early-onset SCFE.
Methods:
We reviewed medical and radiographic records of SCFE patients from 1992 to 2022. Patients under 11 years old and followed up to skeletal maturity were included. Physeal-sparing procedures using a long screw with a short-threaded tip were performed in patients with mild to moderate slips since 2008. Patients were dichotomized into physeal-sparing and traditional in situ fixation (ISF) groups. Radiographic and clinical outcomes were comparatively analyzed between the groups.
Results:
Fifteen patients underwent physeal-sparing procedures, whereas 12 patients underwent traditional ISF. There was no further slippage in either group. During follow-up, slip angle was significantly decreased in the physeal-sparing group compared with the traditional ISF group (22.0 vs. 8.8 deg, respectively, P <0.01). LLD of>20 mm did not occur in the physeal-sparing group, but was observed in the traditional ISF group ( P <0.01). Femoral neck length (FNL), articulo-trochanteric distance (ATD), α angle, and femoral head-neck offset of the physeal-sparing side were comparable to the unaffected healthy side ( P =0.08, P =0.25, P =0.14, P =0.13), but differences were seen in healthy versus traditional ISF sides ( P <0.01, P <0.01, P <0.01, and P <0.01, respectively). In addition, consistent growth was observed in the physeal-sparing side, but premature physeal arrest developed in the traditional ISF side. Six physeal-sparing patients required screw change procedures as the proximal femur outgrew the screw. The physeal-sparing group scored higher modified Harris Hip Score points than the traditional ISF group (89.5 vs. 85.3, respectively).
Conclusions:
Using a long screw with a short-threaded tip can stabilize the proximal femoral physis. It may also allow the continual growth and remodeling of the proximal femur in the treatment of early-onset SCFE.
Level Of Evidence:
Level III.
