Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis

Abstract

Background Several aspects of slipped capital femoral epiphysis (SCFE) treatment remain controversial. Loder's work has been instrumental in changing our understanding and approach to the management of the condition when he introduced the concept of ''slip instability'' and showed that avascular necrosis (AVN) developed in 47% of unstable slips but none of the stable slips. As the two types of SCFE behave differently in terms of presentation, progress and complications, we approached them as two different conditions to highlight these differences. This paper focuses on treatments of stable SCFE. Materials and methods An extensive literature search was carried out from multiple databases. One thousand six hundred and twenty-three citations were screened. Three hundred and sixteen full publications were obtained for further scrutiny. Fifty-eight studies (2262 hips) were included in the review. These studies evaluated 6 interventions. AVN was chosen as a surrogate for bad outcome. Secondary outcomes were chondrolysis (CL), femoro-acetabular impingement (FAI), osteoarthritis (OA) and patients' reported outcomes. The latter were pooled when they met our predefined criteria. Results The type of surgical intervention was an important risk factor. Pinning in situ (PIS) was associated with the lowest AVN rate (1.4%). Moreover, the CL, FAI and OA rates were relatively low in patients who underwent PIS.

Moon (or Eid) Crescent Sign of the Femoral Head

“…Avascular necrosis of the femoral head is one of the most serious complications in children because there is currently no effective treatment. Several authors proposed some predictors for the development of the femoral head AVN, but none is absolute [2,3,7]. Therefore, the postoperative period usually turns into a time of painful suspense.…”

“…SCFE can be also classified as mild, moderate and severe based on the degree of femoral head displacement in relation to the neck. The current trend is to treat mild and moderate SCFE by stabilization without reduction; however, there is increasing evidence to support open reduction and stabilization of severe SCFE [2,3]. AVN is one of the most serious complications of SCFE; particularly the unstable type.…”

Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review

“…It depends on the stability and the degree of severity of the slip [23]. In stable forms [24], in situ pinning with a single crew is the surgical fixation technique mostly used by orthopedic surgeons according to a survey conducted by Wight [23]; especially when it is a mild to moderate stable form. In unstable forms, there is no consensus in the management regarding delay and therapeutic options [24].The treatment differs according to the specialized hospitals, or even within the same structure.…”

“…In stable forms [24], in situ pinning with a single crew is the surgical fixation technique mostly used by orthopedic surgeons according to a survey conducted by Wight [23]; especially when it is a mild to moderate stable form. In unstable forms, there is no consensus in the management regarding delay and therapeutic options [24].The treatment differs according to the specialized hospitals, or even within the same structure. Therefore, the therapeutic options vary according to the stage of severity, the approach, the possibility of reduction, the type of implants, the duration of evolution of symptoms before management.…”

Epifisiolistesis femoral proximal

“…El tratamiento de elección consiste en intervención quirúrgica, mediante la fijación in situ de la epífisis femoral proximal, con la colocación de un tornillo canulado (Figura 3); 15,16 preferentemente deben fijarse ambas caderas, porque en 60% de los casos ocurre el deslizamiento en la cadera contralateral, en promedio a los 18 meses de la intervención, y en 90% de los casos con alteración metabólica. 17,18,3 Figura 1.…”