Drehmann Sign and Femoro-acetabular Impingement in SCFE

Kamegaya, Makoto; Saisu, Takashi; Nakamura, Junichi; Murakami, Reiko; Segawa, Yuko; Wakou, Masanori

doi:10.1097/bpo.0b013e31822ed320

Cited by 34 publications

(29 citation statements)

References 11 publications

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“…Actually, in patients with positive hip impingement sign, either obligatory hip external rotation and abduction with hip flexion (Drehmann's sign [5]) or limitation of hip flexion (\90°) was seen before inducing pain. Drehmann's sign is reportedly useful for evaluating the presence of FAI [13]. The presence of this sign is associated with functional disability in daily living, including inability of Japanesestyle sitting.…”

Section: Methodsmentioning

confidence: 99%

“…We investigated cam-type FAI both preoperatively and postoperatively with a Nötzli a angle [7,22,27] on a Lauenstein view and a modified a angle (b angle) on a Lauenstein view [13]. The b angle measured the angle between a line parallel to the proximal long axis of the femoral shaft and a line from the center of the femoral head to the anterior point where the distance from the head center exceeded the radius of the subchondral surface of the femoral head.…”

Section: Methodsmentioning

confidence: 99%

“…Although remodeling after in situ pinning is expected in more than 1 . 2 of the patients [12,13], acetabular labrum damage and osteochondral damage due to FAI during a period of remodeling have been reported in some patients [17,18]. For unstable SCFE, some surgeons recommend acute open reduction surgery that can resolve FAI [23]; however, there is a serious risk of avascular necrosis (AVN) from this surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Femoroacetabular impingement (FAI) in patients with SCFE has been pointed out in several papers [7,13,16,18,21,22,27]. The decision of whether or not FAI should be resolved surgically when diagnosed remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…We therefore determined whether (1) intertrochanteric flexion osteotomy can resolve the clinical symptoms, (2) radiographic indicators of the Nötzli a angle [7,13,27] or a modified a angle (b angle) [13] on a Lauenstein view can be reduced after intertrochanteric flexion osteotomy, (3) these radiographic indicators are compatible with the clinical signs of FAI, and (4) early osteoarthritic change, AVN, or chondrolysis develops after the osteotomy.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Improvement of Femoroacetabular Impingement After Intertrochanteric Flexion Osteotomy for SCFE

Saisu

Kamegaya

Segawa

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Patients with slipped capital femoral epiphysis (SCFE) may develop cam-type femoroacetabular impingement (FAI). Early management of FAI has been advocated for patients with symptomatic FAI. The various treatment options, including reorientation surgeries, realignment procedures, and osteoplasty, remain controversial. Questions/purposes We asked whether an intertrochanteric flexion osteotomy improved the clinical symptoms of FAI in patients with SCFE and confirmed whether the radiographic signs were compatible with the clinical signs of FAI. Methods We retrospectively reviewed 32 symptomatic patients who underwent 32 intertrochanteric flexion osteotomies for severe SCFE. FAI was diagnosed clinically with a positive impingement sign. The osteotomies were designed preoperatively using CT. Cam-type FAI was evaluated with the modified a angle (b angle) on a Lauenstein view, measured between the proximal femoral shaft axis and the line from the center of the femoral head to the anterior point where the distance of the head center exceeded the femoral head radius. The minimum followup was 2 years (mean, 5 years; range, 2-9 years). Results At last followup, only two patients complained of pain or inconvenience in daily life; the impingement sign was negative in 24 hips (75%). The b angles at last followup were reduced on average by 39°. The postoperative b angle was higher in hips with positive clinical signs of FAI than in those with negative signs. Conclusions Intertrochanteric flexion osteotomy for SCFE improved the clinical and radiographic signs of FAI. The b angle and clinical findings showed compatible improvement. We believe our intertrochanteric flexion osteotomy is a viable option for treating severe SCFE. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Methodsmentioning

confidence: 99%