Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis

Traumatology and Orthopedics of Russia

Bortulev

Baskov

et al. 2022

Background. The appearing of data on cam-type FAI in patients with sequelae of slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement suggests that along with fixation of the proximal femoral epiphysis, modeling of the head-neck transition and restoration of the femoral offsets using arthroscopic techniques should be performed. Meanwhile, it is well known that after epiphyseal fixation, complete remodeling of the epimetaphysis and, consequently, disappearance of the morphological substrate of potential FAI can occur due to the ongoing enchondral and echondral growth. In this regard, the issue of indications for intraarticular interventions in studied patients remains currently open. The aim of the study was to determine the incidence of FAI in the postoperative period in patients with slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement, and to estimate the requirement of further surgical treatment. Methods. The results of the examination of 32 patients with mild chronic epiphyseal displacement in the typical posterior inferior direction who underwent cannulated epiphyseal screw fixation were analyzed for the severity of epimetaphysis remodeling and the presence of FAI in the postoperative period. Clinical, radiological, magnetic resonance, and statistical methods were used. Results. At the age of 18-19 years, FAI with pain syndrome in everyday life was found in 9 (28.1%) patients 8 of them did not have even partial remodeling of the femoral component of the joint, another 9 (28.1%) patients did not suffer from pain syndrome in everyday life, but had other clinical, radiological and MR signs of cam-type FAI. Complete or almost complete remodeling of the proximal femoral epimetaphysis occurred in 14 (43.8%) patients. Conclusion. In our opinion, therapeutic and diagnostic arthroscopy of the hip joint for the purpose of modeling the head-neck transition at the age of 18-19 years is indicated for more than one quarter (28.1%) of the investigated patients because of the presence of reliable signs of FAI.

Section: Introductionunclassified

Tactics of Surgical Treatment of Slipped Capital Femoral Epiphysis Associated With Mild Chronic Epiphyseal Displacement

Traumatology and Orthopedics of Russia

Bortulev

Baskov

et al. 2022

Selected aspects of proximal femoral epiphysis fixation in children with early stages of slipped capital femoral epiphysis

Pediatr Traum Orthop Reconstr Surg

Борисович²,

Bortulev

et al. 2021

BACKGROUND: Epiphyseodesis of the femoral head in the early stages of slipped capital femoral epiphysis using auto-, allografts, and synthetic implant may result in deformities of the femur leading cam-type femoroacetabular impingement and dysfunction of the gluteal muscles. Most surgeons refused this intervention and favor in situ fixation of the epiphysis with modern metal instrumentation and, in particular, cannulated screws with proximal threading. However, the number of screws that provide stable fixation and how to reduce their negative effect on the enchondral growth of the femur remain controversial. AIM: To improve the results of surgical treatment in children with early stages of slipped capital femoral epiphysis. MATERIALS AND METHODS: The radiological results of surgical treatment of 40 patients (80 affected joints) aged from 11 to 14 years with slipped capital femoral epiphysis of stage 1 in one joint and stage 2 in the other joint were analyzed. 20 children were divided into two groups. In each group, the epiphysis was fixed with a 7.0 mm cannulated screw. In the first group, the screw head was held on the cortical layer. In the second group, the screw head was held 510 millimeters away from the cortical layer. Long-term results were evaluated at the age of 1718 years when no signs of enchondral and ecchondral growth of the proximal femur were noted. The obtained data were subjected to statistical analysis. RESULTS: The fixation of the epiphysis was stable in all 80 joints. The shape of epimetaphysis in the joints of stage 2 did not change in most patients by the end of femoral growth. However, the correction recorded in 32.5% of cases was more often observed in children of the second group. The shape of epimetaphysis in all 40 joints with stage 1 of the disease remained normal. The mean length of the epimetaphysis was greater in the second group than in the first group by the end of growth regardless of the stage of the pathologic process during surgery. CONCLUSIONS: The considered method of proximal femoral epiphysis fixation, which excludes the compressive effect of a cannulated screw with proximal threading on the epiphyseal growth cartilage, provides reliable epiphysis retention in the early stages of slipped capital femoral epiphysis. It has a less negative effect on the enchondral growth of the femoral component of the joint.

Surgical Treatment of Juvenile Femoral Head Epiphysiolysis in Children

N.N. Priorov Journal of Traumatology and Orthopedics

Krasnov

Kamosko

et al. 2016

To optimize the anatomical and functional surgical treatment results in patients with early (I-II) stages of juvenile femoral head epiphysiolysis both pre- and postoperative data of clinical, x-ray and magnetic-resonance examinations were analyzed for 120 patients aged 11 - 15 years. Maximum follow up period after surgical interventions, i.e. femoral head epiphysiodesis (n=60) and femoral head epiphysis fixation (n=60) made up 23 and 3 years, respectively. It was shown that surgical intervention for the fixation of femoral head epiphysis ensured reliable stability of the epiphysis preventing the latter from displacement development and progression, and did not exert significant influence upon either femoral neck and head endochondral growth or the length of the upper extremity.