Current practice in the management of acute/unstable slipped capital femoral epiphyses in the United Kingdom and the Netherlands: results of a survey of the membership of the British Society of Children's Orthopaedic Surgery and the Werkgroep Kinder Orthopaedie

Witbreuk, M.M.E.H.; Besselaar, P. P.; Eastwood, Deborah M.

doi:10.1097/01.bpb.0000236234.64893.92

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…Assuming that mechanical instability of the proximal femoral physis is one of the main causes for having AVN develop [35], it would be desirable to detect those cases accurately. The current preferred treatment of acute and unstable slips is percutaneous pinning strictly in situ or with gentle closed reduction, which precludes direct inspection of the physeal stability [4,38,48,51]. Performing the capital femoral realignment procedure based on the surgical dislocation approach [21,31,52], we observed that clinically chronic or stable slips sometimes showed complete epimetaphyseal disruption at surgery and acute or unstable slips sometimes showed no epimetaphyseal disruption.…”

Section: Discussionmentioning

confidence: 98%

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Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) -so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations. Questions/purposes We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/ unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? Methods We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability. Results Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively. Conclusion Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE.

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Section: Discussionmentioning

confidence: 98%

“…Therefore, to prevent further slip progression, surgical fixation of the epiphysis is the recommended primary treatment [2,4,16,34,38,51]. Most SCFE deformities occur with gradual displacement of the femoral head from the metaphysis and with risk of avascular necrosis (AVN) up to 4.6% [28].…”

Section: Introductionmentioning

confidence: 99%

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Some surgeons, particularly in Europe, support the role of primary osteotomy and epiphysiodesis [30][31][32][33] at the time of SCFE diagnosis. In theory, this will restore normal anatomic head-acetabular anatomy and prevent cartilage and labral damage and premature arthritis that occurs early with residual deformity.…”

Section: Femoral Osteotomiesmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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“…Another recent Dutch questionnaire has shown that more than half of the members of the DPOS treat children 75% or more of their time. All of these surgeons will treat DDH [4]. …”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of developmental dysplasia of the hip in the Netherlands: National questionnaire of paediatric orthopaedic surgeons on current practice in children less than 1 year old

Heeres

Witbreuk

Sluijs

2011

Journal of Children's Orthopaedics

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PurposeThere is no consensus in the literature regarding the diagnosis and treatment of developmental dysplasia of the hip (DDH). We designed a national questionnaire to assess the various opinions and current practice of paediatric orthopaedic surgeons in the Netherlands regarding the diagnosis and treatment of DDH in children less than 1 year old.MethodsThe questionnaire was sent to all members of the Dutch Paediatric Orthopaedic Society (DPOS). It discusses different methods and criteria used in the diagnosis of DDH, the use of different therapies and the use of different imaging techniques to evaluate the result of treatment.ResultsWith 38 responders, the overall response rate to the survey was 67%. Most surgeons use clinical, radiographic and/or ultrasound examination for the diagnosis. The starting point of treatment is usually on the mild part of the DDH spectrum. The Pavlik harness is most popular in the treatment of dislocated hips, whereas in dysplastic hips, most surgeons use a rigid splint. The duration of treatment has a wide range and evaluation of the effect of treatment is predominantly done by radiography.ConclusionsThe diagnosis and treatment of DDH in the Netherlands has as much diversity as the literature has recommendations about this subject. The lack of consensus on many aspects of DDH diagnosis and treatment should form the basis for a discussion among Dutch paediatric orthopaedic surgeons. Using the available evidence, it should be possible to formulate a more uniform protocol for the diagnosis and treatment of DDH.

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Current practice in the management of acute/unstable slipped capital femoral epiphyses in the United Kingdom and the Netherlands: results of a survey of the membership of the British Society of Children's Orthopaedic Surgery and the Werkgroep Kinder Orthopaedie

Cited by 33 publications

References 25 publications

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Diagnosis and treatment of developmental dysplasia of the hip in the Netherlands: National questionnaire of paediatric orthopaedic surgeons on current practice in children less than 1 year old

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