Treatment of chronic slipped capital femoral epiphysis

Schumann, E; Zajonz, Dirk; Wojan, Magdalena; Kübler, F. B.; Brandmaier, Philipp; Josten, Ch.; Heyde, Christoph E.; Bühligen, U.

doi:10.1007/s00132-016-3266-5

Cited by 5 publications

(9 citation statements)

References 34 publications

(36 reference statements)

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“…Ongoing growth of the femoral neck forces the epiphyseal part of the screw to glide out of the metaphyseal part, as it follows the moving capital femoral epiphysis. A study has shown a decrease in the slip angle by 11⁰ and the alphaangle by about 30⁰ after stabilization of mild and moderate slips with this screw [10]. Most correction (about 60%) was observed during the first postoperative year, stressing the significance of early diagnosis in order to exploit as much as possible of the remaining growth and remodeling potential of the hip.…”

Section: D the Telescopic Screwmentioning

confidence: 89%

“…Studies that favor simultaneous surgery of the asymptomatic contralateral hip support the rationale that preventive physis stabilization has low perioperative morbidity and complications compared with therapeutic SCFE surgery [10]. Other studies report that preventive physis surgery may prevent a silent slip and radiologic evidence of Cam-type FAI [21].…”

Section: Simultaneous Stabilization Of the Asymptomatic Contralateralmentioning

confidence: 97%

“…The Telescopic Screw consists of two cylindrical parts, one contained in the other [10]. The epiphyseal part is of smaller diameter and has a thread, which is completely driven into the epiphysis.…”

Section: D the Telescopic Screwmentioning

confidence: 99%

“…The Telescopic Screw may be applied in unstable SCFE as well. In this case, an additional smooth pin should be added to provide rotational stability [10].…”

Section: D the Telescopic Screwmentioning

confidence: 99%

“…Femoroacetabular impingement (FAI) is observed in almost all cases of SCFE [1,2,[6][7][8]10,15,[17][18][19][20][21]. Mild slips are not spared from this complication.…”

Section: C Femoroacetabular Impingement and Early Hip Degenerationmentioning

confidence: 99%

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Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

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Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and earlyonset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.

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Section: D the Telescopic Screwmentioning

confidence: 89%

Section: Simultaneous Stabilization Of the Asymptomatic Contralateralmentioning

confidence: 97%

Section: D the Telescopic Screwmentioning

confidence: 99%

“…The Telescopic Screw may be applied in unstable SCFE as well. In this case, an additional smooth pin should be added to provide rotational stability [10].…”

Section: D the Telescopic Screwmentioning

confidence: 99%

“…Femoroacetabular impingement (FAI) is observed in almost all cases of SCFE [1,2,[6][7][8]10,15,[17][18][19][20][21]. Mild slips are not spared from this complication.…”

Section: C Femoroacetabular Impingement and Early Hip Degenerationmentioning

confidence: 99%

See 3 more Smart Citations

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

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Manualmedizinische Auffälligkeiten und Störungen im Kindesalter

Schnellbacher

Seifert

Buchmann

2020

Manualmedizinische Differenzialdiagnostik Und Therapie Bei Säuglingen Und Kindern

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Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis

Morash

Orlik

El-Hawary

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Treatment of stable slipped capital femoral epiphysis (SCFE) most commonly involves in situ fixation with a standard cannulated screw, leading to physeal arrest. Recently, Pega Medical (Laval, Canada) introduced the free-gliding (FG) SCFE screw, which employs a growth-friendly, telescopic design. This study examines femoral neck growth and remodeling over the first 2 postoperative years in stable SCFE treated with FG versus standard screws. Methods: We retrospectively reviewed 32 hips (19 SCFE, 13 prophylactic) in 16 patients treated with FG screws for stable SCFE. We also reviewed 102 hips (63 SCFE, 19 prophylactic, 20 controls) in 55 patients treated with standard screws. Immediate postoperative radiographs were compared with 1- and 2-year follow-up images. Results: For the overall study cohort, mean age at surgery was 12.2±1.9 years, with a mean slip angle of 26.9±18.0 degrees. In FG SCFE hips, the alpha angle remodeled 12.9±19.2 degrees in the first postoperative year (P=0.018) and articulotrochanteric distance decreased by 4.2±4.6 mm at 2 years (P=0.018). In standard SCFE hips, the alpha angle remodeled 4.3±11.3 degrees at 1 year (P=0.014), while articulotrochanteric distance decreased by 4.5±3.2 mm at 2 years (P<0.001). By 2 years, FG screws lengthened more in prophylactic (4.8±3.4 mm) than SCFE hips (1.7±1.8 mm, P=0.027). Conclusions: Greater remodeling of femoral neck cam deformity occurs when treating SCFE using an FG screw. Further research is required to measure the impact of this finding on femoroacetabular impingement and degenerative arthritis. In addition, FG screws allow ongoing growth of prophylactically treated hips, while standard screws promote coxa breva. Level of Evidence: Level III—retrospective comparative, therapeutic study.

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Treatment of chronic slipped capital femoral epiphysis

Abstract: Surgical treatment with a DET screw seems to be a safe procedure for both the affected hip and the hip to be treated prophylactically. This method is an adequate alternative to the widespread technique of pinning with K‑wires.

Cited by 5 publications

References 34 publications

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Manualmedizinische Auffälligkeiten und Störungen im Kindesalter

Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis

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