Severe hip infection after a prophylactic contralateral fixation in slipped upper femoral epiphysis: a case report

Bertani, Antoine; Launay, Franck; Glard, Yann; Chrestian, P.; Jouve, J.-L.; Bollini, G.

doi:10.1097/bpb.0b013e32832dbeb4

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Studies have suggested an in situ pinning of a normal hip as a result of a higher slipping rate (2335 times) than that of a normal hip [ 17 ]. In contrast, other authors have argued against prophylactic pinning for the unaffected hip due to the exposure of the normal hip to surgical pinning, which could damage the joint, thereby resulting in further exposure of the patient to surgical risks such as infection, fracture, pain, avascular necrosis, and chondrolysis [ 18 ]. An analysis of some of the cases revealed devastating deleterious effects of the complications, with some of the cases advocating for non-surgical intervention in managing an unaffected hip.…”

Section: Discussionmentioning

confidence: 99%

“…Other categories of SUFE classification are acute, acute-on-chronic, and chronic. A SUFE is regarded as acute if symptoms are present for less than three weeks, while the acute-on-chronic hip occurs upon exacerbation of the symptoms in an asymptomatic hip, which may result in complications such as chondrolysis, secondary osteoarthritis, and avascular necrosis [ 18 - 20 ]. The current study revealed only two acute cases, both of which were associated with trauma.…”

Section: Discussionmentioning

confidence: 99%

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Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management

Maatough¹,

Leonard²,

Elbardesy³

et al. 2023

Cureus

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Background and objectiveSlipped upper femoral epiphysis (SUFE) is one of the most common hip pathologies in adolescents and preadolescents, the diagnosis of which is often missed due to delayed presentations. In this study, we aimed to conduct a retrospective analysis of SUFE cases treated in the hospital during the 15-year period from 2003 to 2018 and examine its bilateral presentation and the need for prophylactic pinning on the unaffected side. MethodsThis retrospective cohort study involved cases that were treated from 2003 to 2018. The case details were retrieved from the medical records department. Records older than 15 years were excluded owing to their inaccuracy, and 26 cases of SUFE were included in the final analysis. Each case was subjected to physical and radiological examinations of the symptomatic and asymptomatic hips. IBM SPSS Statistics v23 (IBM Corp., Armonk, NY) was used for data analysis. ResultsIn this study, six of the 26 patients had bilateral SUFE and required subsequent surgical pinning. The duration of surgical interventions ranged from two to 22 months, while the mean intervention duration was 10.3 months. Among the cases, 61.5% (p<0.05) were idiopathic in nature upon documentation. However, 19% (p<0.05) of the cases were shown to be associated with an underlying condition or prior symptoms of the condition, whereas 7.6% (p<0.05) had an increased basal metabolic index; 11% (p<0.05) of the cases had an inherited family history of SUFE. A comparison between males and females showed a slightly higher frequency of complications in males (n=14) than in females (n=12) (p=0.556). The age of the patients at the presentation ranged between and 10-15 years, with an average age of 12.5 years. ConclusionBased on our findings, males were affected more than females and most of the cases were idiopathic. There is no significant evidence to support the need for prophylactic pinning of the unaffected hip. We recommend prospective studies with a larger sample of patients to gain more insight into the topic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management

Maatough¹,

Leonard²,

Elbardesy³

et al. 2023

Cureus

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“…Since pinning of a normal hip is not free from complications, it is essential to identify the patients at the risk of subsequent contralateral slip development and recommend prophylactic pinning of the contralateral hips. [6] There is no consensus in risk evaluation, and it is commonly made according to patients' radiological parameters that evaluate growth potential. [7][8][9] In this study, we aimed to compare the radiological parameters of unilateral SCFE patients who reached skeletal maturity without developing subsequent contralateral slips and unilateral SCFE patients who developed subsequent contralateral slips.…”

Section: Introductionmentioning

confidence: 99%

Which factor is more reliable considering prophylactic pinning of contralateral hip of unilateral SCFE patients?

Akpınar

Sevencan

Özyalvaç

et al. 2023

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study evaluates the radiological parameters of developing subsequent contralateral slips in unilateral slipped capital femoral epiphysis (SCFE) patients at the time of initial presentation. METHODS: The study group included the review of unilateral SCFE patients treated between June 2007 and August 2018. Age, gender, side, stability, posterior slope angle, grade of slip, modified Oxford bone age score (mOBAS), the Risser classification, and the appearance of the triradiate cartilage were evaluated retrospectively. Data were analyzed between two groups: subsequent contralateral SCFE (SCFESC) patients that developed contralateral slip during follow-up and unilateral SCFE (SCFEU) patients that did not develop contralateral slip up to skeletal maturity. Descriptive statistics were used to compare risk factors between groups. RESULTS: This study included 48 patients and 6 patients (12.5%) developed a SCFESC. Only mOBAS was significantly different between groups. The mOBAS scores in SCFESC were 18 in 2 patients (33.3%), 19 in 4 patients (66.7%). The mOBAS scores in SCFEU were 18 in 1 patient (2.4%), 19 in 24 patients (57.1%), and >20 in 17 patients (40.5%). In the SCFESC group, all patients had a Risser score of 0 and all had open triradiate cartilage. CONCLUSION: Patients with unilateral SCFE are at risk for SCFESC, and the mOBAS is the best predictor of risk assessment. We agree that mOBAS score of 16,17 or 18 patients’ contralateral hips can be prophylactically pinned. We also suggest pinning or close screening of mOBAS 19 patients that some carry relatively high risk of subsequent contralateral slip.

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“… 11 , 12 Moreover, prophylactic surgery may predispose toward certain complications, such as: infection, implant breakage, avascular necrosis, chondrolysis or subtrochanteric fracturing of the femur. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Analysis on the risk of contralateral proximal femoral epiphyseal slippage using the modified Oxford score

Soni

Valenza

Ueda

et al. 2015

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo determine the application of the modified Oxford score among patients with proximal femoral epiphyseal slippage (PFES) as an aid to indicating prophylactic surgical treatment on the contralateral hip.MethodsRetrospective analysis on the medical files of patients attended at the institution where the authors work. From these, patients attended between 2008 and 2011 who presented unilateral PFES and were followed up for a minimum of two years were selected. Patients were excluded if they presented endocrine disease, metabolic disease, Down syndrome or radiographs that were inadequate for determining the modified Oxford score. The initial radiographs received scores ranging from 16 to 26. Statistical analysis was used to determine whether the scoring was predictive of future development of contralateral slippage.ResultsAmong the 15 patients with unilateral PFES that were selected, five (33.3%) evolved with contralateral slippage. The patients were divided into two groups. Four patients were considered to present risk and three of them developed contralateral slippage. In the group that was considered not to present risk, there were 11 patients and two of these evolved with contralateral slippage. Thus, there was a tendency for the patients in the group that developed the disease to differ from the group that did not develop it, in relation to the risk classification.ConclusionAlthough application of the modified Oxford score was not statistically significant in our sample, we noted a tendency toward contralateral slippage among hips with low scores.

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Severe hip infection after a prophylactic contralateral fixation in slipped upper femoral epiphysis: a case report

Cited by 6 publications

References 17 publications

Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management

Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management

Which factor is more reliable considering prophylactic pinning of contralateral hip of unilateral SCFE patients?

Analysis on the risk of contralateral proximal femoral epiphyseal slippage using the modified Oxford score

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