The contralateral slip

Abstract

Between July 1994 and June 2004, 60 patients with 76 slipped upper femoral epiphyses were managed within the adult trauma service of three hospitals. Treatment was by a single cannulated screw. Of these cases, 53 were unilateral, in 17 of which uncomplicated prophylactic fixation of the contralateral hip was performed. Of the other 36 cases, nine presented with a subsequent slip despite ongoing out-patient care. The subsequent slip was unpredictable in timing and unrelated to the age at the initial slip. It was more often unstable and in one case avascular necrosis developed. The overall rate of avascular necrosis, although in accordance with the literature, was 60% in acute unstable slips with a slip angle greater than 40 degrees. In our experience, prophylactic fixation was safer than continued observation of the contralateral hip.

Comparison of the Femoral Head Height/Neck Length Ratio Between the Unaffected Hip of Patients With a Unilateral Slipped Femoral Head and the Hips of Individuals Without a Slipped Femoral Head

“…This study assessed whether there was any difference in the head height/neck length ratio of the femur on the contralateral side of patients with unilateral epiphysiolysis, in comparison with a control group. The aim was to determine whether this index might be an indicator for the risk that slippage of the contralateral epiphysis of the femur might occur, given that early diagnosis of contralateral involvement is still a matter of controversy and discussion in the literature 1 , 6 , 7 , 8 , 9 , 10 , 16 , 17 , 18 . The factors involved in such occurrences are still under investigation, in an attempt to obtain parameters that might, more securely, identify patients who should undergo prophylactic surgical treatment on the contralateral hip, before the disease is manifested with greater morbidity and complications.…”

“…Bidwell and Stott, among others, considered that PEF before the age of 12 years was a risk factor for contralateral slippage, independent of the patient's gender (8) . However, there are authors who have not correlated the risk of PEF with age (9) . Data on skeletal maturation as a protection factor (when advanced) or a risk factor (when delayed) have been highlighted.…”