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

Seller, Konrad; Raab, Peter; Wild, Alexander; Krauspe, Rüdiger

doi:10.1097/01202412-200107000-00006

Cited by 14 publications

(24 citation statements)

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“…Treatment of SCFE is always surgical. Screws [4] and Kirschner wires [21] are currently the implants of choice for stabilising the femoral epiphysis. The goals of treatment in epiphyseal slips are to stop further slippage by stable fixation with a low complication rate and to restore good hip function with painless motion by remodelling the joint.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis

Seller

Wild

Westhoff

et al. 2006

International Orthopaedics (SICOT)

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Treatment of slipped capital femoral epiphysis (SCFE) is still controversial. Agreement has not yet been reached on the appropriate time to perform surgery, the necessity of repositioning manoeuvres, the type of implants for stabilisation, or the need for prophylactic treatment of the contralateral side. In this retrospective study, we present 29 patients with unstable (acute and acute-on-chronic) SCFE treated by internal fixation of the epiphysis with three or four Kirschner wires both therapeutically on the affected side and prophylactically on the not (yet) affected side. After hardware removal and mean follow-up of 3.5 years, radiological and clinical examination of hip function was carried out. X-ray in two planes showed no incidence of any slip progression. Applying the score used by Heyman and Herndon, 18 results (62.1%) were classified as excellent, nine (31.1%) as good, one (3.4%) as fair, and one (3.4%) as poor. The rate of severe complications such as chondrolysis and avascular necrosis of the femoral head was low in our series (0% and 6.8%, respectively). This form of therapeutic management shows good clinical results with low complication rates. The slip can be efficiently stabilised, progression is reliably prevented, and remodelling of the joint gives the patient good overall hip function. We see no indication for emergency surgery.

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Section: Introductionmentioning

confidence: 99%

Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis

Seller

Wild

Westhoff

et al. 2006

International Orthopaedics (SICOT)

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“…Furthermore, we believe that there may also be a risk of premature closure when several pins are used, 3,21,22 if they do not cross the physis in a perpendicular manner. In order to reduce the risk of unwanted physeal closure, it is important to use a technique that will allow the femoral neck to continue to grow and develop in a normal manner after surgery.…”

Section: Technical Considerations In Contralateral Fixationmentioning

confidence: 99%

“…Multiple pins or screws are sometimes used with the aim of obtaining maximum fixation of the epiphysis. 21 However, Blanco, Taylor and Johnston 26 and O'Beirne et al 27 claimed that one screw or pin was sufficient when stabilising hips with slips. They noted that the risk of pin penetration, with its potentially serious complications, would be significantly reduced if one pin was used rather than two or more.…”

Section: Technical Considerations In Contralateral Fixationmentioning

confidence: 99%

“…As stated above, there may also be a risk of premature closure of the physis when multiple pins cross the physis at different non-perpendicular angles. 21 Furthermore, Karol et al 28 performed biomechanical tests on bovine femurs using one or two screws for fixation and concluded that the small gain in stiffness from using a second screw did not offset the increased risk of complications. These studies thus suggest that using a single correctly positioned pin or screw, which is safer than using more, should also be sufficient for prophylactic fixation.…”

Section: Technical Considerations In Contralateral Fixationmentioning

confidence: 99%

“…3,4,21,29 We strongly recommend, however, that prophylactic fixation be performed by an experienced surgeon. If using a single correctly positioned device that offers safe anchorage in the epiphysis and allows the femoral neck to continue to grow, the risk of complications is likely to be small.…”

Section: Technical Considerations In Contralateral Fixationmentioning

confidence: 99%

See 2 more Smart Citations

Management of the contralateral hip in patients with unilateral slipped upper femoral epiphysis

Hansson

Nathorst-Westfelt

2012

The Journal of Bone and Joint Surgery. British volume

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In the majority of patients with slipped upper femoral epiphysis only one hip is involved at primary diagnosis. However, the contralateral hip often becomes involved over time. There are no reliable factors predicting a contralateral slip. Whether or not the contralateral hip should undergo prophylactic fixation is a matter of controversy. We present a number of essential points that have to be considered both when choosing to fix the contralateral hip prophylactically as well as when refraining from surgery and instead following the patients with repeat radiographs.

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Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading

Sailhan

Courvoisier²,

Brunet³

et al. 2011

Journal of Children's Orthopaedics

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

Cited by 14 publications

References 0 publications

Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis

Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis

Management of the contralateral hip in patients with unilateral slipped upper femoral epiphysis

Continued growth of the hip after fixation of slipped capital femoral epiphysis using a single cannulated screw with a proximal threading

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