Risk-Benefit Analysis of Prophylactic Pinning in Slipped Capital Femoral Epiphysis

Abstract

There is a broad and controversial discussion about the surgical procedure and the type of hardware for internal transfixation of the epiphysis and metaphysis in slipped capital femoral epiphysis (SCFE). Prophylactic pinning is even more controversial. One hundred and nine patients showing SCFE underwent a one-stage bilateral fixation of the epiphysis with three or four Kirschner wires (pins). From these 109 patients (69 male and 40 female), 94 had an unilateral slip and were operated prophylactically on the contralateral side. There were no complications such as avascular necrosis of the femoral head, chondrolysis, bone fracture, failure of metal implant, osteomyelitis or deep wound infection either at the time of surgery or at the minimum follow-up of 1 year with prophylactic pinning in SCFE. Therefore, we consider pinning allows for efficient stabilization, reliably preventing any progression of SCFE on the affected side and, furthermore, prevents the incidence of a secondary slip on the primarily nondisplaced contralateral side. The transfixation of epiphysis and metaphysis with Kirschner wires (pins) shows good subjective and objective long-term results compared with other surgical methods and implants. There is only a low morbidity rate with this method, because reoperations may only become necessary in the younger age group owing to normal growth of the femoral neck, compared with a high benefit from prophylactic surgical treatment of the nonaffected opposite side at the time of unilateral onset of the disease. The pins may no longer catch the epiphysis but further growth will allow for remodeling of the femoral head and for an optimal neck/shaft ratio. In case of further growth and relative shortening of the pins, refixation may become necessary. Therefore, we like to recommend the Kirschner-wire transfixation (pinning) of the epiphysis and metaphysis in patients with SCFE for primary treatment of SCFE as well as for prophylactic pinning of the contralateral side in one sitting.

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

“…Several studies have addressed the question of whether the contralateral hip in a patient presenting with unilateral slipped capital femoral epiphysis (SCFE) should be pinned prophylactically [6,16,36]. Proposed parameters to determine which patients should undergo prophylactic pinning include age [6,25,33], sex [9], weight [25], modified Oxford bone age score [31], presence of an endocrine disorder [23,26], and surgeon's assessment regarding the families' ability to return for regular followup [16].…”

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

“…Slipped capital femoral epiphysis (SCFE) is the most common disorder of the hip in adolescents [1,2]. In SCFE a non-traumatic displacement of the epiphysis from the metaphysis into medial, dorsal and caudal directions occurs through the physeal plate.…”

“…As its aetiology and treatment concepts have not been resolved [3][4][5], the disease is an often discussed topic to date. The debate about the treatment concepts is still controversial [2,6]. Residual changes can lead to the development of secondary osteoarthritis.…”

Computerized Navigation for Treatment of Slipped Femoral Capital Epiphysis

“…A skin line geometric technique, used to preplan the screw entry point had, been described by Canale [10]. Several authors have described mathematical formulas and radiographic templates to ensure correct screw placement [9,11,12]. Recently, Rooks et al [11] recommended the tip of the screw to be positioned 8 mm from the subchondral bone or within one third of the femoral head radius-whichever is closest.…”