Conventional treatment of mild slipped capital femoral epiphysis consists of fixation in situ with wires or screws. Recent contributions to the literature suggest that even a mild slip may lead to early damage of the acetabular labrum and adjacent cartilage by abutment of a prominent femoral metaphysis. It has been suggested that the appropriate treatment in mild slipped capital femoral epiphysis should not only prevent further slipping of the epiphysis, but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. Between October 1984 and December 1995 we treated 16 patients for unilateral mild slipped capital femoral epiphysis by fixation in situ with Kirschner wires. In this study we have reviewed these patients for clinical and radiological evidence of femoroacetabular impingement. There was little clinical indication of impingement but radiological evaluation assessing the femoral head-neck ratio and measuring the Nötzli alpha angle on the anteroposterior and cross-table radiographs showed significant alterations in the proximal femur. None of the affected hips had a normal head-neck ratio and the mean alpha angle was 86 degrees (55 degrees to 99 degrees ) and 55 degrees (40 degrees to 94 degrees ) on the anteroposterior and lateral cross-table radiographs, respectively. While our clinical data favours conventional treatment, our radiological findings are in support of restoring the anatomy of the proximal femur to avoid or delay the development of femoroacetabular impingement following mild slipped capital femoral epiphysis.
Prophylactic contralateral fixation in unilateral slipped capital femoral epiphysis (SCFE) remains a controversial issue. In this study, 66 patients treated for unilateral SCFE (July 1997-April 2009) were screened for complications with need for surgical reintervention in the asymptomatic contralateral hip. Except for one patient, prophylactic fixation was performed in all cases. Major complications such as avascular necrosis were not seen; minor complications such as wound revision occurred in 4.6% (three of 65). In 16.9% (11/65) secondary loss of fixation with need for second fixation occurred. As the need for second fixation arose mostly bilaterally (10.7%, 7/65), only four patients (6.2%) required an additional surgical procedure for second fixation. Children who needed second fixation were significantly younger (11.8 years) than those who did not (13.1 years, P=0.013). In conclusion, this retrospective analysis shows that prophylactic contralateral fixation in SCFE is a safe procedure with no major complications and an acceptable rate of minor complications. When Kirschner wires are used for prophylactic pinning, there is a possibility of secondary loss of fixation due to length growth at the level of the physis. To avoid the need for secondary fixation, screw epiphysiodesis might be considered.
Purpose The a-angle is a frequently used measurement to quantify head-neck offset pathology in cam-type femoroacetabular impingement. However, diverging norm values and reference intervals have been described, especially in men.Methods The a-angle, the head-neck offset ratio and the triangular index were measured on anteroposterior and lateral radiographs of 339 (170 men and 169 women) subjects without evident underlying hip pathology. Results For male subjects, the mean a-angle was 49.4°( SD 10.5°) on anteroposterior and 49.1°(SD 10.6°) on lateral radiographs, whereas for female subjects, it was 45.0°(SD 8.0°) and 46.1°(SD 9.9°), respectively. Thus, calculated upper limits of reference intervals in the population screened were 70°for both radiographic projections in men and 61°(anteroposterior) and 66°(lateral) in women. Conclusion These data substantiate recent findings that the pathological threshold of the a-angle in male subjects may be lower than that previously assumed. Level of evidence Diagnostic, Level III.
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