Outcome of Slipped Capital Femoral Epiphysis in Renal Osteodystrophy

Pseudohypoparathyroidism: A rare cause of bilateral slipped capital femoral epiphysis

“…Review of the literature suggests that preoperative serum alkaline phosphatase level of Ͻ500 IU and a serum parathyroid hormone level of Ͻ200 pg/mL serve as general guidelines for successful stabilization and optimal physeal growth. 11 However, if control of hyperparathyroidism is difficult or prolonged, surgical stabilization with either single screw or multiple pins to prevent further slipping of the epiphysis and promotion of the premature fusion of the physis should be undertaken to prevent further skeletal damage. 11 Most importantly, because hyperparathyroidism in patients with PHP is potentially reversible and no intrinsic abnormality of the physis exists, the prognosis for continued physeal growth in these young patients without progression of deformity is good if metabolic correction can be accomplished.…”

Significantly lower femoral neck growth in screw fixation of the asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis

“…On the one hand, smooth pins or wires are intuitively believed to cause less damage to the physis. In several studies with pin fixation, persisting physeal growth was observed [5][6][7]20], but even in these patients, premature closure of the physis or premature cessation of growth could still be seen in up to 70% [5,6]. On the other hand, screw fixation with the thread crossing the physis is intuitively believed most likely to cause epiphyseodesis.…”

“…Most authors agree that physeal growth should be preserved, especially in the very young, to prevent secondary deformities and -particularly in unilateral fixation -leg-length discrepancy. Various techniques such as hook pins, modified Steinmann pins, modified screws, Crawford Adam pins, or dynamic screws have been attempted to preserve residual growth at the level of the physis [5,7,[9][10][11][12].…”

“…There is some concern that fixation might lead to premature cessation of growth of the proximal femoral physis, resulting in coxa brevis, coxa vara, trochanteric overgrowth, and reduced abduction [1,[5][6][7][8], especially in the very young [8]. Thus, different implants such as Crawford Adam pins, modified screws with fewer threads, or partly threaded Steinmann pins [5,7,[9][10][11][12] have been used in the hope of minimizing growth disturbance at the level of the physis. However, when smooth pins or wires are used, there is a high rate of secondary loss of fixation because of longitudinal growth at the level of the physis [6,13,14], especially in very young patients [14].…”

Treatment of SCFE in a healthy 5-year-old child

“…There are no reported case series of SCFE in children much younger than 10 years, and this subset defines a treatment challenge because of their significant growth potential. Physeal closure in very young patients has a mild effect on the overall longitudinal growth, but more significantly, it reduces the remodeling potential of the deformed proximal femur and may also lead to coxa vara [9,10]. The youngest patient report in the literature is of a 3-year-old child with pre-existing pseudohypoparathyroidism [11].…”