Abstract
IntroductionIn slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis. Early recognition and adequate surgical fixation is essential for a good functional outcome. The fixation should be secured until the closure of the epiphysis to prevent further slippage. A slipped capital femoral epiphysis should not be confused with a femoral neck fracture.Case presentationCase 1 concerns a 15-year-old boy with an adequate initial screw fixation of his slipped capital femoral epiphysis. Unfortunately, it was thought that the epiphysis had healed and the screw was removed after 11 weeks. This caused new instability with a progressive slip of the femoral epiphysis and subsequently re-fixation and a subtrochanteric correction osteotomy was obligatory. Case 2 concerns a 13-year-old girl with persistent hip pain after screw fixation for slipped capital femoral epiphysis. The screw was removed as lysis was seen around the screw on the hip X-ray. This operation created a new unstable situation and the slip progressed resulting in poor hip function. A correction osteotomy with re-screw fixation was performed with a good functional result.ConclusionA slipped epiphysis of the hip is not considered ‘healed’ after a few months. Given the risk of progression of the slip the fixation material cannot be removed before closure of the growth plate.
Highlights
In slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis
Given the risk of progression of the slip the fixation material cannot be removed before closure of the growth plate
We present two cases with complications after screw removal to highlight the serious consequences of the loss of adequate fixation before the end of growth plate closure
Summary
Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder. In this condition the metaphysis of the femoral neck displaces anteriorly and superiorly to the femoral head [1]. At that time a mild epiphysiolysis was diagnosed on presentation in the emergency room He was admitted with bed rest and three days later an in situ fixation was performed with one cannulated screw (Figure 1). As it was thought that the fracture had consolidated, the screw was removed 11 weeks after initial placement After this procedure had been performed his hip became increasingly painful and he experienced reduced mobility. Persistence of disability he was referred to our orthopedic children’s clinic several months later At that time he had a painful gait with a severely limited left hip function with 70 degrees of flexion. After referral to an orthopedic surgeon, a mild SCFE was diagnosed on the X-frog-lateral view She was admitted and on the same day an in situ screw fixation. The Harris Hip Score was 96 and the X-ray showed a Southwick angle of 20 degrees and no signs of AVN or chondrolysis
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