Open Bone Peg Epiphysiodesis for Slipped Capital Femoral Epiphysis

Rao, Sudhir B.; Crawford, Alvin H.; Burger, Robert R.; Roy, Dennis R.

doi:10.1097/01241398-199601000-00008

Cited by 49 publications

(9 citation statements)

References 51 publications

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“…Thirteen of 15 studies used internal fixation devices for epiphyseal stabilization that are detailed in Table 2. Depending on the time period over [16,19] included patients treated primarily by bone-peg epiphysiodesis; however, within these reports, there was variable use of internal fixation or postoperative spica casting.…”

Section: Resultsmentioning

confidence: 99%

“…The most frequently reported technique was internal fixation using either pins or screws and more recently using cannulated screws. Peterson et al [16] and Rao et al [19] reported on the use of bone-peg epiphysiodesis supplemented with either spica casting or internal fixation. There was no identifiable correlation between method of fixation and rate of avascular necrosis.…”

Section: Discussionmentioning

confidence: 99%

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Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

Zaltz

Baca

Clohisy

2013

Clinical Orthopaedics &Amp; Related Research

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Background The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques. Questions/purposes We therefore addressed the following questions: (1) What is the rate of osteonecrosis of the femoral head after treatment of unstable SCFE? (2) What treatment modalities have been used for unstable SCFE and (3) what are the reported complications? Methods We performed a systematic electronic literature search for the keywords unstable and slipped capital femoral epiphysis and identified 199 articles. Of these, 60 met our inclusion criteria. Fifteen articles were included for analysis. Results The literature concerning the treatment and results of unstable SCFE is retrospective Level IV data that suggest an overall rate of osteonecrosis of 23.9%. Multiple treatment modalities were used for unstable SCFE treatment with varying, inconsistently recorded complications over the reporting period. Conclusions We found limited data concerning the rate of osteonecrosis and complications after treatment of unstable SCFE. Considering recent widespread interest in the modified Dunn procedure and the possibility of iatrogenic osteonecrosis, there is a need for prospective studies to identify complications and establish outcome based on standardized scores for established and emerging treatments of unstable SCFE.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

Zaltz

Baca

Clohisy

2013

Clinical Orthopaedics &Amp; Related Research

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“…Recurrent or persistent slippage of the CFE has been described in other studies utilizing open bone graft epiphysiodesis [1,29,42]. This has usually been attributed to graft resorption or fracture.…”

Section: Discussionmentioning

confidence: 95%

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

Thompson

Lea

Chin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression. Questions/purposes We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach. Methods We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression. Results Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9

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“…These are epiphysiodesis [10,11] [20,23,24,27] included 84 patients with unstable slips that were treated with open reduction and fixation. Sixty eight percent were treated within 24 hours of the presentation.…”

Section: Discussionmentioning

confidence: 99%

“…A number of treatments options were reported for the study population including epiphysiodesis [10,11], pinning in situ (PIS) [1,7,[12][13][14][15][16][17][18][19], closed reduction and pinning (CRIF) [4,5,11,15,16,18,[20][21][22][23][24][25], open reduction and physeal osteotomy (PO) [1,7,15,26] open reduction and internal fixation (ORIF) [23][24][25]27] and surgical dislocation (SD) [13,15,[28][29][30].…”

Section: Description Of Studiesmentioning

confidence: 99%