Abstract
BackgroundThe appropriate treatment in mild slipped capital femoral epiphysis (SCFE) should not only prevent further slipping of the epiphysis but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. The aim of this study was to quantify length of the remodeling phase mediated by growth of the femoral neck, after treatment of SCFE with a screw designed to prevent premature closure of the physis and provide stability.MethodsBetween 2001 and 2011, 38 patients with unilateral mild SCFE were treated by fixation in situ using a modified screw which does not cause premature physeal arrest. Twenty-four patients were investigated for clinical and radiological evidence of femoroacetabular impingement immediately after surgery, at 6- and 12-month follow-ups. Statistical analysis was performed comparing measurements of neck length and the α angle of the affected and contralateral side.ResultsMean α angle immediately after pinning was 56.2 ± 10.6° on the anteroposterior view and 91.4 ± 8.2° on the lateral view. These measurements significantly improved at 6 months post-op to 48.9 ± 5.4° on the anteroposterior view and 51.2 ± 6.5° on the lateral view (p < 0.0001). At 12 months from surgery, AP view α angle was 43.0 ± 2.8° (p < 0.0001) and lateral view was 44.2 ± 4.1° (p < 0.0001). We observed a similar growth rate and speed of the femoral neck of both the affected and unaffected sides during the first year of treatment. The clinical results in all patients were rated as excellent.ConclusionOur data supports the use of a surgical technique that allows residual growth of the femoral neck following mild SCFE and permits restoration of the anatomy of the proximal femur while avoiding development of femoroacetabular impingement following mild SCFE.
Highlights
The appropriate treatment in mild slipped capital femoral epiphysis (SCFE) should prevent further slipping of the epiphysis and address potential femoroacetabular impingement by restoring the anatomy of the proximal femur
Full list of author information is available at the end of the article changes occur at the acetabular labrum and adjacent cartilage which act as precursors of osteoarthritis of the affected hip joint [9, 10]. These two studies, which analyzed moderate and severe SCFE, demonstrated articular erosions and scars and/or tears of the labrum, with damage to the articular cartilage ranging from superficial abrasions to fullthickness loss caused by a prominent femoral metaphysis protruding beyond or at least level with the physis
These studies recommended an osteochondroplasty at the femoral head-neck junction in addition to stabilization of the epiphysis in situ, in an attempt to reduce risk of developing secondary osteoarthritis [11]
Summary
Two studies suggest that after slippage of the epiphysis, These two studies, which analyzed moderate and severe SCFE, demonstrated articular erosions and scars and/or tears of the labrum, with damage to the articular cartilage ranging from superficial abrasions to fullthickness loss caused by a prominent femoral metaphysis protruding beyond or at least level with the physis. Due to such findings, these studies recommended an osteochondroplasty at the femoral head-neck junction in addition to stabilization of the epiphysis in situ, in an attempt to reduce risk of developing secondary osteoarthritis [11]
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