Posterior Sloping Angle of the Capital Femoral Physis

Barrios, Carlos; Blasco, M Angeles; Blasco, M Carmen; Gascó, José

doi:10.1097/01.bpo.0000158811.29602.a5

Cited by 70 publications

(25 citation statements)

References 18 publications

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“…Once the triradiate cartilage has closed, the risk of a contralateral SCFE is only 4% [117], although another study did not find any association between the status of the triradiate cartilage, other skeletal maturity markers, and subsequent bilaterality [118]. The risk of bilaterality is increased when the posterior slope angle of the capital femoral epiphysis is higher [119, 120]. …”

Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

2011

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The etiology of slipped capital femoral epiphysis (SCFE) is unknown with many insights coming from epidemiologic/demographic information. A systematic medical literature review regarding SCFE was performed. The incidence is 0.33/100,000 to 24.58/100,000 children 8 to 15 years of age. The relative racial frequency, relative to Caucasians at 1.0, is 5.6 for Polynesians, 3.9 for Blacks, and 2.5 for Hispanics. The average age is 12.0 years for boys and 11.2 years for girls. The physiologic age when SCFE occurs is less variable than the chronologic age. The average symptom duration is 4 to 5 months. Most children are obese: >50% are >95th percentile weight for age with average BMI is 25–30 kg/m2. The onset of SCFE is in the summer when north of 40°N. Bilaterality ranges from 18 to 50%. In children with bilateral involvement, 50–60% present with simultaneous SCFEs and those who present with a unilateral SCFE and subsequently develop a contralateral SCFE do so within 18 months. The age at presentation is younger for those who present with a unilateral SCFE and later develop a contralateral SCFE. The age-weight, age-height, and height test are useful to differentiate between an idiopathic and atypical SCFE.

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Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

2011

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“…Barrios recommended prophylactic pinning over 12° PSA, Zenios over 14.5° PSA and Phillips over 14° PSA. 4-6 Thus, at around 15° of retroversion, the hip is at risk of starting to slip. In a biomechanical saw-bone model, the energy to failure halved with every 5° increase of PSA from 15° to 30° and is virtually non-measurable over 50°.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

Leblanc

Bellemore

Cheng

et al. 2017

Journal of Children's Orthopaedics

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PurposeSlipped capital femoral epiphysis (SCFE) is a deformity of the proximal femur secondary to widened and unstable physis. In stabilising the slip, gold standard treatments stop growth and involve premature physeal closure, which prevents the remodelling of the acquired deformity and creates a leg length discrepancy that may be significant in younger patients.MethodsWe measured the impact of placing threaded screws across the proximal femoral physis by measuring the centre-trochanteric distance (CTD) and articulo-trochanteric distance (ATD) in participants with or without prophylactic fixation. We then compared the mechanical performance of static (stainless and titanium cannulated Synthes screws) and potentially growing implants (Synthes SCFE screw and Pega Medical Free Gliding screw) in a validated synthetic bone model.ResultsIn the review of 30 non-fixed and 60 fixated hips over a mean follow-up of 1.9 years, we have noted a significant difference in pre/post CTD and ATD, as well as the change in CTD and ATD over time. In the biomechanical study, the newer implants allowing growth (Synthes SCFE screw and Pega Medical Free Gliding screw) were both shown to be at least non-inferior.ConclusionsThe primary deformity of a SCFE in itself alters hip mechanics. Also, as confirmed in this study, there is a secondary deformity that is created by static fixation and relative trochanteric overgrowth. To help remodel mild deformities and prevent secondary trochanteric overgrowth, growing implants seem to be non-inferior to the more standard means of fixation in static testing.

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“…Slipped capital femoral epiphysis (SCFE) is a disease of unknown etiology, but mechanical, biological and hereditary factors are likely to play a role (Barrios et al 2005, Murray and Wilson 2008). The rationale for treatment of SCFE is to restore hip function, prevent further slip, and to reduce the risk of subsequent degenerative changes.…”

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confidence: 99%

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Lehmann¹,

Engesæter²,

Laborie³

et al. 2011

Acta Orthopaedica

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Background and purposeSlipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins.Patients and methodsAll 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis.Results67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis.InterpretationIn situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck.

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Posterior Sloping Angle of the Capital Femoral Physis

Cited by 70 publications

References 18 publications

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

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