Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires

Abstract

Treatment of slipped capital femoral epiphysis is still controversial with regard to the implants used for stabilization and the need for prophylactic treatment of the contralateral, unaffected, side. The objective of this study was to ascertain whether prophylactic transfixation of the epiphysis with Kirschner wires in patients with unstable slipped capital femoral epiphysis resulted in significant disturbance of the growth plate and impairment of further growth of the femoral neck and head. Between 1990 and 1999, 29 patients with unstable slipped capital femoral epiphysis were simultaneously treated with internal fixation of the epiphysis and metaphysis with 3-4 Kirschner wires on the affected and the not (yet) affected side. After a mean follow-up of 3.5 years, we evaluated the hip joints radiologically, analysing different roentgenological parameters (CCD angle, femoral head diameter, length of the femoral neck and sphericity of the femoral head). CCD angle, femoral head diameter and length of the femoral neck showed statistically significant (P<0.001, Student's t-test) differences between the affected and unaffected, but prophylactically pinned, sides. Asphericity of the femoral head was found in six cases only on the affected side, whereas all hips, which were operated prophylactically, showed spherical femoral heads at follow-up (P<0.02, Pearson's chi test). These results indicate that the slip itself may cause impairment of the femoral growth plate in patients with unstable slipped capital femoral epiphysis and not stabilization with Kirschner wires. Compared with other series from the literature using different implants (screws, nails), prophylactic transfixation of the epiphysis and metaphysis with Kirschner wires is less compromising to the growth plate on the not (yet) affected side.

The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

“…Therefore the development of efficient treatment strategies based upon a reliable evaluation tool is mandatory. Up to now outcome studies have evaluated only subjective, clinical and radiological parameters [13][14][15]. Functional aspects and especially the influence on gait have been commonly neglected.…”

Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

“…Potential mechanisms for the development of osteonecrosis may be partially dependent on the type of treatment but include kinking of periosteal blood vessels resulting from torsional deformity, synovitis associated with the trauma, vascular tamponade resulting from intracapsular hematoma, timing of treatment, and location of fixation devices within the epiphysis. Multiple treatment algorithms that were developed to address these theoretical causes include intentional delay in treatment [11], preoperative traction [13,19,20], both open and closed urgent reduction and fixation [8,17], and open or percutaneous capsulotomy [8,12,19] and are all associated with developing osteonecrosis. Patients with unstable SCFE often presented with substantially more deformity, often correctable, and were more likely to undergo attempted reduction, either intentional or inadvertent.…”

Behandlung der chronischen Epiphyseolysis capitis femoris

“…Auch ein weiteres Wachstum der Hüfte wird durch die KirschnerDrähte nicht wesentlich behindert. Hierdurch ist ein Remodeling des Hüftkopfes durch das weitere Wachstum möglich [1,32]. Der Nachteil der KirschnerDrähte liegt in der Tatsache, dass sie im Verlauf dislozieren oder den Gelenkspalt perforieren können und somit letztlich ihre Haltefunktion verlieren und neu platziert werden müssen.…”

“…Somit ist in unserer Untersuchung die Revisionsrate geringer als bei der Verwendung von Kirschner-Drähten, bei denen schon die Rate für Reoperationen aufgrund des Herauswanderns der Drähte bei ca. 27 % liegt [32]. In der Untersuchung der dynamischen Gleitschrauben von Hackenbroch wurden wenige Komplikationen berichtet [10].…”