The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis

Perry, Daniel C.; Arch, Barbara; Appelbe, Duncan; Francis, Priya; Craven, Joanna; Monsell, Fergal; Williamson, Paula; Knight, Marian

doi:10.1302/0301-620x.104b4.bjj-2021-1709.r1

Cited by 13 publications

(26 citation statements)

References 27 publications

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“…The routine treatment for slipped capital femoral epiphysis (SCFE), with the lowest risk, is ‘to pin in situ’ to induce fusion of the physis and prevent progression of the slip. 1,2 However, this can result in a symptomatic residual proximal femoral deformity. 3-5…”

Section: Introductionmentioning

confidence: 99%

“…These include emergency reduction, 6 intracapsular osteotomy, 7-9 and dislocation with osteotomy. 10 The use of these techniques varies widely, 1,2,11-14 and all carry a risk of avascular necrosis. 1,9,10…”

Section: Introductionmentioning

confidence: 99%

“…10 The use of these techniques varies widely, 1,2,11-14 and all carry a risk of avascular necrosis. 1,9,10…”

Section: Introductionmentioning

confidence: 99%

“…The routine treatment for slipped capital femoral epiphysis (SCFE), with the lowest risk, is 'to pin in situ' to induce fusion of the physis and prevent progression of the slip. 1,2 However, this can result in a symptomatic residual proximal femoral deformity. [3][4][5] Surgery for SCFE must be safe, prevent progression of the slip, and limit the development of iatrogenic avascular necrosis.…”

Section: Introductionmentioning

confidence: 99%

“…These include emergency reduction, 6 intracapsular osteotomy, [7][8][9] and dislocation with osteotomy. 10 The use of these techniques varies widely, 1,2,[11][12][13][14] and all carry a risk of avascular necrosis. 1,9,10 A device which allows the continued growth of the femoral neck after pinning in situ can permit remodelling and reduce the incidence of persistent deformity and femoroacetabular impingement.…”

Section: Introductionmentioning

confidence: 99%

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The Free-Gliding screw for slipped capital femoral epiphysis

Buchan

Lindisfarne

Stabler

et al. 2023

The Bone & Joint Journal

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Aims Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. Methods All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years’ follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein’s line were recorded. Subanalysis was performed according to sex and age. Results A total of 19 hips in 13 patients were included. The mean age of the patients at the time of surgery was 11.5 years (9 to 13) and the mean follow-up was 63 months (45 to 83). A total of 13 FG SCFE screws were used for the fixation of mild or moderate SCFE, with six contralateral prophylactic fixations. No hip with SCFE showed a further slip after fixation and there were no complications. Lengthening occurred in 15 hips (79%), with a mean lengthening of the barrel of 6.8 mm (2.5 to 13.6) at final follow-up. Remodelling occurred in all hips with lengthening of the barrel. There was statistically more lengthening in patients who were aged < 12 years, regardless of sex (p = 0.002). Conclusion The FG SCFE screw is effective in preventing further slip in patients with SCFE. Lengthening of the barrel occurred in most hips, and thus allowed remodelling. This was most marked in younger children, regardless of sex. Based on this study, this device should be considered for use in patients with SCFE aged < 12 years instead of standard pinning in situ. Cite this article: Bone Joint J 2023;105-B(2):215–219.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…10 The use of these techniques varies widely, 1,2,11-14 and all carry a risk of avascular necrosis. 1,9,10…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Free-Gliding screw for slipped capital femoral epiphysis

Buchan

Lindisfarne

Stabler

et al. 2023

The Bone & Joint Journal

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Comparing pinning in situ and capital realignment procedures for severe, stable slipped capital femoral epiphysis: a systematic review

Kennedy,

Pullan,

El-Bakoury

2023

Journal of Hip Preservation Surgery

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In severe, stable slipped capital femoral epiphysis, it is unclear whether pinning in situ (PIS) or capital realignment procedures (CRPs) are superior. Our primary aim was to compare patient-reported outcome measures (PROMs) following each strategy. Secondary aims were to compare rates of femoral head avascular necrosis (AVN) and complications. MEDLINE, Embase and Cochrane databases were searched according to an agreed strategy. Narrative review articles, case reports, letters to the editor and articles not written in English were excluded. The risk of bias was assessed using the Newcastle–Ottawa Scale. Of the 132 citations identified, 127 were excluded following de-duplication and application of the exclusion criteria. Three observational studies comparing PIS with CRP and two case series considering CRP alone were identified. One article was considered fair quality, and four articles were considered poor. In total, 198 hips from five studies were included (66 PIS, 132 CRP). PIS was associated with moderate-good functional outcomes, and CRP with good-high outcomes. Two comparative studies reported significantly better PROMs following CRP. AVN was reported in 1.5% following PIS and 10.6% following CRP. Regarding other complications, chondrolysis occurred in 3.0% following PIS and 2.4% following CRP. Femoroacetabular impingement rates were markedly higher following PIS (60.6% versus 2.3%). Reoperation rates were also greater following PIS (34.5% versus 13.3%). PIS tends to be associated with favourable AVN rates, but CRP with favourable PROMs and complication rates. However, comparisons were drawn from heterogeneous studies lacking long-term follow-up. Further high-quality research is required.

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Quantifying Risk Factors for Slipped Capital Femoral Epiphysis and Postslip Osteonecrosis

Zusman,

Goldstein,

Yoo

2023

Journal of Pediatric Orthopaedics

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Background: Slipped capital femoral epiphysis (SCFE) is a disorder of the proximal femoral physis occurring in late childhood and adolescence. Previously postulated risk factors include obesity and endocrinopathies. The purpose of this investigation was to identify risk factors for developing SCFE, as well as postslip osteonecrosis (ON), among the United States pediatric population. Methods: A national database investigation was performed using PearlDiver Technologies, Inc., queried for SCFE and ON using International Classification of Disease codes (2010 to 2020). Regression analyses to determine the risk of developing a SCFE, and ON after a patient has already been diagnosed with a SCFE (“postslip”). Propensity matching between SCFE and control groups generated a pseudo-randomization model to compare the relative risk. Results: There were 11,465 patients with SCFE available in the database, matched with 134,680 controls. After matching, vitamin D deficiency, obesity, hypothyroidism, and growth hormone use were risk factors for developing SCFE [relative risk ranges from 1.42 (95% CI: 1.21-1.39, vitamin D deficiency) to 3.45 (95% CI: 3.33-3.57, obesity)]. ON risk factors were vitamin D deficiency [1.65 (1.26-2.14)] and hypothyroidism [1.49 (1.10-2.07)]. Conclusions: This United States national database study quantified risk factors of developing an SCFE and postslip ON. Obesity is the most significant risk factor for the development of a slip, but not ON. Growth hormone use, hypothyroidism, and vitamin D deficiency are also risk factors for SCFE development, whereas only the latter two were associated with ON. These findings demonstrate the public health implications of obesity and comorbid conditions in pediatric hip pathology. Level of Evidence: Level III.

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The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis

Cited by 13 publications

References 27 publications

The Free-Gliding screw for slipped capital femoral epiphysis

The Free-Gliding screw for slipped capital femoral epiphysis

Comparing pinning in situ and capital realignment procedures for severe, stable slipped capital femoral epiphysis: a systematic review

Quantifying Risk Factors for Slipped Capital Femoral Epiphysis and Postslip Osteonecrosis

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