SCFE

PURPOSE: Stable slipped capital femoral epiphysis (SCFE) has been shown to have a lower rate of avascular necrosis than unstable SCFE. A recent study found increased intracapsular hip pressures in the setting of unstable SCFE, thus increasing the risk of osteonecrosis. The purpose of this study was to measure the intracapsular pressure in stable SCFE and compare it to the intracapsular pressure in normal hips and in unstable SCFE. METHODS: Thirteen hips with stable SCFE and 15 hips with unstable SCFE were identified...

Slipped capital femoral epiphysis (SCFE) is a condition of the immature hip in which mechanical overload of the proximal femoral physis results in anterior and superior displacement of the femoral metaphysis relative to the epiphysis. The treatment of SCFE is surgical, as the natural history of nonsurgical treatment is slip progression and early arthritis. Despite advances in treatment, much controversy exists regarding the best treatment, and complication rates remain high. Complications include osteonecrosis, chondrolysis, SCFE-induced impingement, and related articular degeneration, fixation failure and deformity progression, growth disturbance of the proximal femur, and development of bilateral disease...

BACKGROUND: Femoroacetabular impingement (FAI) may be common after slipped capital femoral epiphysis though the actual frequency is unknown. The purpose of this study was to determine the frequency of symptomatic FAI in young adults after slipped capital femoral epiphysis and define its relationship with slip severity. METHODS: We retrospectively reviewed a consecutive series of 49 patients (65 hips) to determine patient and slip characteristics and treatments. Patients were then recalled for clinical and radiographic review to assess symptoms, particularly impingement, and outcomes after skeletal maturity...

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15...

BACKGROUND: The management of unstable slipped capital femoral epiphysis (SCFE) is controversial. A high incidence of avascular necrosis (AVN) has been reported after unstable SCFE. METHODS: Twenty-eight consecutive patients with thirty unstable SCFE underwent urgent reduction and fixation with two 6.5-mm cannulated screws. Positional reduction was performed in 25 cases. Arthrotomy was performed percutaneously in 16 cases and as part of an open capsulotomy in 5 cases...

BACKGROUND: The purpose of the present study was to determine whether the modified Oxford bone score can be used as a predictor for the risk of developing contralateral slipped capital femoral epiphysis (SCFE) in children who present with a unilateral slip. METHODS: We identified 260 patients treated for unilateral SCFE between 1980 and 2002 and followed them up to skeletal maturity or until development of contralateral slip. Exclusion criteria included patients with endocrine or metabolic disorder, Down syndrome, and those with radiographs inadequate to determine the modified Oxford bone score...

The patient with an unstable slipped capital femoral epiphysis poses a challenging problem to the treating physician to improve the position of the displaced epiphysis to avoid femoroacetabular impingement without developing avascular necrosis (AVN)-a potentially devastating complication. Although the standard operative procedure of in situ pinning following an incidental reduction while positioning the patient on the table, has been the mainstay of treatment in North America, other viable options are available including a surgical dislocation approach to the hip followed by a modified Dunn osteotomy with control of the retinacular vessels, reduction of the epiphysis, and internal fixation with pins or screws...

BACKGROUND: Flexion-rotational osteotomy of the proximal femur is an accepted intervention in the management of severe deformity and femoral acetabular impingement secondary to slipped capital femoral epiphysis (SCFE). The impact of this surgical intervention on gait kinematics and kinetics, validated functional questionnaires, and patient outcomes has not been well studied. The purpose of this study was to analyze the changes in standard gait parameters of patients with moderate to severe SCFE who were treated with a flexion-rotational osteotomy...

BACKGROUND: Slipped capital femoral epiphysis, a common disorder in adolescents, may be increasing in incidence in North America because of the obesity epidemic. In most cases, the slip is mild and can be treated with in situ fixation. Even in more severe cases of a stable slip, in situ fixation remains a widely accepted choice. When the slip is acute and unstable, treatment remains controversial. We reviewed the orthopaedic literature and our personal experience in managing acute, unstable slipped capital femoral epiphysis...

BACKGROUND: Reduction of unstable slipped capital epiphysis has a bad reputation, especially in severe slips. Treatment frequently causes avascular necrosis (AVN). This study analyzes the role of capsulotomy with evacuation of intraarticular fluid and gentle reduction done as an emergency procedure followed by fixation with unthreaded Kirschner wires (K-wires). METHODS: We treated 64 consecutive cases of unstable slips (37 boys and 27 girls) following the same protocol...

Surgical hip dislocation (SHD) is a versatile approach used to address both intra-articular and extra-articular pathology around the hip joint in both pediatric and adult patients. It allows anterior dislocation of the femoral head for direct visualization of the hip joint while preserving femoral head vascularity and minimizing trauma to the abductor musculature. Previously described indications for SHD include femoroacetabular impingement, deformity resulting from Legg-Calve-Perthes disease, slipped capital femoral epiphysis, periarticular trauma, benign lesions of the hip joint, and osteochondral lesions...

BACKGROUND: Modified Dunn osteotomy has gained popularity over the past decade in the treatment of moderate to severe adolescent slipped capital femoral epiphysis. The purpose of this study was to retrospectively evaluate a consecutive series of adolescent slipped capital femoral epiphysis patients treated with the modified Dunn procedure at a single institution. We analyze the indications for the procedure as well as the complications after surgical treatment. METHODS: Forty-three adolescent patients (18 boys and 25 girls) were treated with the modified Dunn procedure at our institution between September 2001 and August 2012...

In 83 children with slipped capital femoral epiphysis, puberty was staged at the time of diagnosis using bone age, closure of triradiate cartilage, Risser index, and the pubertal diagram of Dimeglio. In boys 95% and in girls 83% of slips occurred during the accelerating phase of puberty (stage 1 and 2), in which mainly the limbs grow. In boys (54%) and in girls (66%), most slips occurred in stage 1. The triradiate cartilage was still open at the time of diagnosis in 65% of boys and 64% of girls. Staging puberty is useful to differentiate the risk for slipped capital femoral epiphysis and to evaluate the risk for a contralateral slip...

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BACKGROUND: Chronic pain is associated with increased anxiety, depression, and maladaptive behaviors, especially in adolescents. We hypothesized that adolescents with chronic hip pain selected for hip preservation surgery (HPS) would demonstrate increased anxiety and depression compared with same-age peers. We designed a study to assess the psychological state of adolescents before HPS. METHODS: We prospectively evaluated 58 patients (23 males, 35 females), average age 16...

Developmental and acquired abnormalities of the hips are common in childhood. Radiographs, MR imaging, CT, and nuclear medicine play an important role in the diagnosis and management of these disorders. Knowledge of the surgical and clinical treatments of these disorders is important to interpret accurately the radiology studies and impact treatment of the children.

Hip injuries in young athletes are being diagnosed with increasing frequency. Improvements in diagnostic imaging and surgical technologies have helped facilitate the diagnosis of intra- and extra-articular derangements that were previously untreated in this age group. Athletic injuries of the hip in the young athlete encompass both osseous and soft-tissue etiologies, which can be the result of a single traumatic event or repetitive microtrauma or may be associated with an underlying pediatric hip disorder. Without accurate diagnosis and management, these injuries may result in debilitating consequences...

BACKGROUND: Valgus slipped capital femoral epiphysis (SCFE), defined as posterolateral slippage of the proximal femoral epiphysis on the metaphysis, is an uncommon occurrence. The purpose of this study was to review our institution's experience with valgus SCFE to better describe its prevalence, clinical presentation, and treatment. METHODS: Radiographs of patients undergoing treatment of SCFE between 1996 and 2008 were reviewed. Valgus SCFE was identified by increased prominence of the lateral femoral epiphysis relative to the lateral femoral neck and an increased anteroposterior physis shaft angle...

A retrospective review was performed of 106 patients to determine the effect of knee pain as the initial complaint of slipped capital femoral epiphysis (SCFE). Sixteen (15%) patients had a primary complaint of distal thigh or knee pain or both at initial presentation to our institution or to a referring physician. Ninety (85%) patients described primarily hip, groin, or proximal thigh discomfort. Of the 106 patients with SCFE, 65 patients received no operative treatment before being evaluated at our institution and were the subject of the remainder of the study...

BACKGROUND: Previous long-term studies have shown good outcomes for most patients after in situ pinning of slipped capital femoral epiphyses (SCFE). However, concern is growing about the effects of leaving the epiphysis in a nonanatomic position. We undertook a retrospective study to carefully document patient-reported outcomes and need for additional surgery after in situ pinning of SCFE. Further, we sought to determine the risk factors for persistent pain and dysfunction after in situ pinning...