Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis

Abstract

Treatment of slipped capital femoral epiphysis (SCFE) is still controversial. Agreement has not yet been reached on the appropriate time to perform surgery, the necessity of repositioning manoeuvres, the type of implants for stabilisation, or the need for prophylactic treatment of the contralateral side. In this retrospective study, we present 29 patients with unstable (acute and acute-on-chronic) SCFE treated by internal fixation of the epiphysis with three or four Kirschner wires both therapeutically on the affected side and prophylactically on the not (yet) affected side. After hardware removal and mean follow-up of 3.5 years, radiological and clinical examination of hip function was carried out. X-ray in two planes showed no incidence of any slip progression. Applying the score used by Heyman and Herndon, 18 results (62.1%) were classified as excellent, nine (31.1%) as good, one (3.4%) as fair, and one (3.4%) as poor. The rate of severe complications such as chondrolysis and avascular necrosis of the femoral head was low in our series (0% and 6.8%, respectively). This form of therapeutic management shows good clinical results with low complication rates. The slip can be efficiently stabilised, progression is reliably prevented, and remodelling of the joint gives the patient good overall hip function. We see no indication for emergency surgery.

Significance of clinical and radiographic findings in young adults after slipped capital femoral epiphysis

“…Additionally, a major factor for successful hip joint preservation is the extent of irreversible cartilage damage prior to surgery [5]. As a consequence of our findings and controversies in the literature [3], there is a need for the implementation of new and more sophisticated magnetic resonance imaging techniques that are sensitive to biochemical changes within the joint cartilage such as delayed gadolinium enhanced MRI of cartilage (dGEMRIC), which might have the potential to further enlighten the interrelation of hip deformity, cartilage degeneration and the development of OA.…”

“…In SCFE, a direct correlation has been presumed between slip severity and patient long-term outcome with less favourable results for patients with more severe deformity [1][2][3]. OA due to SCFE is reported to develop in up to 41% of the cases [4].…”

The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

“…Therefore the development of efficient treatment strategies based upon a reliable evaluation tool is mandatory. Up to now outcome studies have evaluated only subjective, clinical and radiological parameters [13][14][15]. Functional aspects and especially the influence on gait have been commonly neglected.…”

Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading

“…Single-pin fixation has been favored increasingly because the overall rate of complications seems to be directly related to the number of pins or screws inserted [14,15].…”