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In Situ Screw Fixation for Stable Slipped Capital Femoral Epiphysis Is Safely Treated in Both Inpatient and
Philip Nowicki1, Stephen Carveth, Kyle Miller
1From the Corewell Health Helen DeVos Children's Hospital, Michigan State University College of Human Medicine Department of Surgery, Grand Rapids, MI (Nowicki, Cassidy, and Sawyer), Iowa Ortho, Des Moines, IA (Carveth), Gillette Children's Hospital, St Paul, MN (Miller), Corewell Health Department of Orthopaedic Surgery, Grand Rapids, MI (Flakne), ECU Health, Greenville, NC (Kramer), University of Kentucky Department of Orthopedic Surgery and Sports Medicine, Lexington, KY (Reynolds), LeBonheur Children's Hospital, Memphis, TN (Rowland), and Campbell Clinic Orthopaedics, LeBonheur Children's Hospital, Memphis, TN (Kelly).
Background:
Patients diagnosed with slipped capital femoral epiphysis (SCFE) are admitted and treated with timely screw stabilization to prevent instability. This study compares the safety of SCFE stabilization in an inpatient versus outpatient setting, specifically evaluating the rates of revision procedures and complications between each setting.
Methods:
A retrospective review of all stable SCFEs treated at two, level 1, pediatric trauma centers with a minimum follow-up of 12 months was done. Comparisons were made between inpatient and outpatient groups. General demographics were collected along with slip severity as determined by Southwick angle. Outcomes reviewed included symptomatic femoroacetabular impingement and postoperative complications, including slip angle progression and revision screw fixation. Independent t -test was used to evaluate quantitative variables, chi-squared test for qualitative variables, and logistic regression for differences between severity groups. P values of <0.05 were considered notable.
Results:
One hundred seventy-one SCFEs in 140 patients were reviewed. Overall, 108 were stabilized as an inpatient and 63 as an outpatient. No notable differences between either group were found when assessing for overall complications ( P = 0.1705) and need for revision surgery ( P = 0.1657). Frog-leg lateral hip angles progressed markedly over time for all patients ( P = 0.0413) but not between patient groups ( P = 0.0981). The odds of complication were 2 times higher ( P = 0.023), and symptomatic femoroacetabular impingement were 2.1 times higher ( P = 0.0027) for each increase in slip severity relative to the previous severity level. Interrater reliabilities for Southwick angles were good or excellent across all time measurements (intraclass correlation ≥0.8).
Discussion:
Our data confirm that no difference exists between complication and revision rates with SCFE stabilization in an inpatient or outpatient setting. Although we did not perform a comprehensive safety analysis, outpatient SCFE stabilizations were associated with a low complication rate when performed in a high-volume center. More work is needed to establish proper outpatient SCFE treatment guidelines.
Level Of Evidence:
Level III case-control series.
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