[Percutaneous in situ pin fixation in superior femoral epiphysiolysis]

The purpose of this study was double. We evaluated long term results in 30 patients who had in situ pinning fixation. We tried to assess the advantage of pinning versus screw fixation.

We reviewed retrospectively 30 cases treated for SCFE by in situ pinning fixation. Between august 1985 and may 1995, 33 hips were treated (3 bilateral cases). The age averaged 10 years and 3 months. Twenty-one cases were chronic (64 per cent), 8 cases were acute forms (21 per cent) and 4 acute cases revealed progressive cases (14 per cent). There were 19 boys and 11 girls. The osteosynthesis was made with 3 pins (except in 4 cases with only 2 pins).

The follow-up ranged from 20 to 50 months (average 35 months). The upper femoral growth plate was closed at an average of 16 months after surgery (6 months to 21 months). Three prophylactic controlateral fixations were performed before our protocola was established. No pin penetration was noted. No chondrolysis or avascular necrosis was noted. Complications were: 2 superficial hematomas with spontaneous resorption, 1 lateral pin migration without consequence on fixation, 1 break-pin in soft tissue without clinical consequence. The main complication was, in one case, a secondary slipping of the epiphysis after premature pin removal. Hip function was normal except in 2 cases with loss of motion in internal rotation.

Stiffness of the screw is the most important advantage. A single screw seems to be enough. Removal of the screw is difficult, sometimes impossible.

Percutaneous in situ pinning in SCFE is recommended. It is an easy surgical technique with an absence of complication such as chondrolysis or avascular necrosis in our experience. It is also the easiest method for hardware removal.