The Universal Entry Point with oblique screw is superior to fixation perpendicular to the physis in moderate slipped capital femoral epiphysis

Abstract

Purpose Stable slipped capital femoral epiphysis (SCFE) is often treated with in situ pinning, with the current gold standard being stabilization with a screw perpendicular to the physis. However, this can lead to impingement and a potentially unstable construct. In this study we model the biomechanical effect of two screw positions used for SCFE fixation. We hypothesize that single screw fixation into the centre of the femoral head from the anterior intertrochanteric line (the Universal Entry Point or UEP) provides a more stable construct than single screw fixation perpendicular to the physis with an anterior starting point. Methods Sawbone models of moderate SCFE were used to mechanically test the two screw constructs and an unfixed control group. Models were loaded to failure with a shear load applied through the physis in an Instron mechanical tester. The primary outcomes were maximum load, stiffness and energy to failure. Results Screw fixation into the centre of the femoral head from the UEP resulted in a greater load to failure (+19%), stiffness (+13%) and energy to failure (+45%) than screw fixation perpendicular to the physis. Conclusions In this sawbone construct, screw fixation into the centre of the femoral head from the UEP provides greater biomechanical stability than screw fixation perpendicular to the physis. This approach may also benefit by avoiding an intracapsular entry point in soft metaphyseal bone and subsequent risk of impingement and loss of position.

The Utility of Virtual Reality in Orthopedic Surgical Training

“…Given the limited sample size, the pin-physeal angle was the only statistically significant improvement noted in the VR group. While the argument could be made that this is not clinically relevant as there is emerging evidence that screw angle does not necessarily affect stability, 25 the accepted standard for screw placement remains perpendicular to the physis. 26 As such, residents were instructed on perpendicular placement, and individuals who completed VR training demonstrated significantly increased accuracy, a highly transferable skill.…”