Slipped Capital Femoral Epiphysis In Patients Research Articles

The Effect of Human Growth Hormone Treatment on the Development of Slipped Capital Femoral Epiphysis: A Cohort Analysis With 6 Years of Follow-up.

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that can result in substantial complications, impacting the quality of life. Human Growth Hormone (HGH) administration may elevate the risk of SCFE, though the relationship remains unclear. Clarifying this association could enable better monitoring and earlier diagnosis of SCFE in patients receiving HGH. The aim of the study is to investigate the association between HGH administration and the incidence of SCFE. This retrospective cohort study utilized data from the TriNetX research database from January 2003 to December 2022. The study included 2 cohorts: an HGH cohort including 36,791 patients aged below 18 years receiving HGH therapy and a control group consisting of patients who did not receive HGH therapy. A 1:1 propensity score matching technique was employed to ensure comparability between the HGH and no-HGH cohorts. The primary outcome measure was the development of SCFE identified by International Classification of Diseases codes. For comparative analysis, both risk ratios (RR) and hazard ratios were computed to evaluate the association between HGH therapy and the development of SCFE. The HGH cohort had an increased risk of SCFE compared with the no-HGH cohort (RR: 3.5, 95% CI: 2.073, 5.909, P <0.001) and had an increased hazard of developing SCFE (hazard ratio: 2.627, 95% CI: 1.555, 4.437, P <0.001). Patients with higher exposure to HGH (defined as >10 prescriptions) had an RR of 1.914 (95% CI: 1.160, 3.159, P =0.010) when compared with their counterparts with ≤10 prescriptions. In the largest study to date, HGH administration was associated with an elevated risk of SCFE in children in a dose-dependent manner. Level III-therapeutic retrospective cohort study.

Slipped Capital Femoral Epiphysis after 2 Months from Starting Growth Hormone Therapy

AbstractRecombinant growth hormone (GH) is a widely used hormonal therapy for children and adolescents with GH deficiency or short stature related to certain conditions. Generally, GH therapy has a good safety profile; however, it could have rare but significant orthopaedic complications including slipped capital femoral epiphysis (SCFE). Pediatric endocrinologists are aware of these possible complications, and they are responsible for appropriately counseling their patients before commencing this hormone. However, the pediatric endocrinologist may not be the first clinician who encounters the orthopaedic complications of GH, as the patient may seek an emergency medical opinion from people from other specialties. Here, we report the case of a 13-year-old Iraqi adolescent boy who presented with limping that appeared only 2 months after receiving GH (0.035 mg/kg/d). He was diagnosed with SCFE in a relatively very short time after commencement of the treatment. Despite this, the patient was not considered to be at high risk of SCFE. A careful evaluation of SCFE in patients complaining of a limp or hip and knee pain during GH therapy is highly recommended.

Среднесрочные результаты внесуставной корригирующей остеотомии бедра при юношеском эпифизеолизе головки бедренной кости

Despite the diversity of surgical options for slipped capital femoral epiphysis (SCFE), there is an ongoing search for the technique that would ensure a satisfactory outcome, stable fixation of bone fragments and a low rate of complications. The aim of this study was to improve the surgical technique for SCFE in patients with moderate and severe SCFE. The study included 52 children (16 girls and 36 boys) aged 10-15 years (the mean age was 13.2 years) with chronic severe (Krechmar’s stage III) stable (according to Loder’s classification) SCFE. The control group (n = 16) underwent a classic Imhauser procedure; the main group (n = 36) underwent a triplane osteotomy proposed by the authors of the study. The patients were examined prior to surgery and in the late follow-up period (the mean follow-up time was 4.7 years, ranging from 1 to 10 years). The procedure included a clinical examination, history taking, radiography to measure the slip angle and the severity of the slip, and the Harris hip score to assess hip function. After 4.7 years, both groups demonstrated an increase in the range of motion, in comparison with their preoperative results (p ≤ 0.05), good Harris hip scores (94 points in the main group and 81 points in the control group. Postoperative radiographs showed consolidation of the bone, recovery of the proximal femur anatomy. Leg length discrepancy improved significantly in both groups. The proposed technique for extraarticular osteotomy allows recovering the length of the affected leg, the anatomy and physiology of the hip joint, is simple and less traumatic.

Predicting subsequent contralateral slipped capital femoral epiphysis: an evidence-based approach.

PurposeThe purpose of this study was to identify risk factors for developing a subsequent contralateral slipped capital femoral epiphysis (SCFE) and provide a prediction score to quantify risk of subsequent slip at the time of initial presentation.MethodsThis retrospective study included patients that presented with a unilateral SCFE between 2006 and 2017. Chart and radiographic review were performed to collect demographic, clinical and radiographic risk factors. Descriptive statistics, univariate analyses and multivariate regression analysis were used to compare risk factors between patients that did or did not develop a subsequent contralateral SCFE.ResultsThis study included 183 patients and 33 patients (18%) developed a subsequent contralateral SCFE. Younger age at time of initial presentation, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between both sides during index presentation were significant predictors of subsequent contralateral SCFE. Specifically, age ≤ 11 years, modified Oxford Score ≤ 20 and difference in epiphyseal-diaphyseal angle of ≤ 21° between both hips were predictive of a contralateral slip (Area Under the Curve = 0.78; p < 0.05). The presence of each risk factor increased the risk of subsequent contralateral SCFE and having all three risk factors increased the risk to 73%.ConclusionThere is a significant risk of subsequent contralateral SCFE in patients with unilateral SCFE, and predictive risk factors include younger age, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between the affected and unaffected hips.Level of EvidenceLevel III

Rates of Contralateral SCFE in the United States: Analysis of the Pediatric Health Information System.

Slipped capital femoral epiphysis (SCFE) is relatively common in pediatric patients. Subsequent contralateral SCFE is also common and rates of bilateral SCFE have been reported to range from 12% to 80% in the literature. The purpose of this study was to determine the rates of subsequent contralateral SCFE in patients who present with unilateral SCFE in the United States and determine risk factors for the development of subsequent contralateral SCFE. The authors performed a retrospective study using data from the Pediatric Health Information System (PHIS). Patients who underwent in situ pinning of a unilateral SCFE between 2004 and 2016 were included in this study and followed prospectively to determine subsequent contralateral SCFE. They excluded patients who underwent bilateral pinning at index admission. Descriptive, univariate, and multivariate statistics were used to determine rates of subsequent contralateral SCFE and identify factors associated with contralateral SCFE. This study included 9755 patients who underwent in situ pinning for unilateral SCFE. The mean age at the time of index SCFE was 11.9 years (SD, 1.7) and ~62% of patients were male individuals. Subsequent contralateral SCFE occurred in 1077 (11%) patients at an average of 277 days (range, 7 to 1523 d) after the index procedure. Patients who developed a subsequent contralateral SCFE were younger at the time of index SCFE than patients who did not develop a contralateral SCFE (11.3 vs. 12 y old, P<0.01). In multivariate analysis, older children had a lower risk of subsequent contralateral SCFE (adjusted odds ratio, 0.8; 95% confidence interval, 0.77-0.83), and the odds of subsequent contralateral SCFE decreased by 20% with each increasing year in age. The rate of subsequent contralateral SCFE is ~11% in the United States, and younger patients are more likely to develop a contralateral SCFE than older patients. Prophylactic pinning should be considered in younger patients with unilateral SCFE, and patients should be followed until skeletal maturity to monitor for subsequent contralateral SCFE. Level III.

A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis.

Introduction. The purpose of this study was to identify deficiencies in pediatric residents’ and pediatricians’ knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs (P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs (P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions (P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.

Association between body mass index-for-age and slipped capital femoral epiphysis: the long-term risk for subsequent slip in patients followed until physeal closure.

BackgroundChildren who present with idiopathic slipped capital femoral epiphysis (SCFE) have an increased risk of developing bilateral disease. Predicting which patients will develop problems with bilateral hips is important for determining treatment algorithms. This is a retrospective observational study that evaluates the relationship and risk between body mass index (BMI)-for-age and unilateral and bilateral SCFE in patients followed until physeal closure.MethodsThis is a retrospective study of all patients with SCFE presenting to one institution from 1998–2005. Using the Center for Disease Control (CDC) references, BMI-for-age was calculated for each patient. The patients were followed up until complete closure of the bilateral proximal femoral physes, which was considered completion of the study. Statistical analysis for significant differences between groups was performed using the Kruskal–Wallis test for equality of populations. A logistic regression, controlling for age and gender, was used to identify BMI-for-age as a risk factor and to determine the significance of the odds ratios (ORs) for the relevant categorical variables—obese, overweight and healthy weight.ResultsEighty patients (56 male, 24 female) presented to a single institution between 1998 and 2005 with a diagnosis of SCFE. The mean age of patients was 12.2 years at initial presentation (range 8.5–16). Forty-eight patients (32 male, 16 female) presented with unilateral SCFE, with 22 of the 48 patients having a BMI for-age percentile ≥95 %. Thirty-two patients (24 male, 8 female) presented with bilateral SCFE, with 29 of the 32 patients having a BMI-for-age percentile ≥95 %. Patients with a BMI-for-age ≥95 % had a significantly increased risk of presentation with bilateral slips (OR 4.83; relative risk [RR] 3.01; p < 0.05]. All but one patient in this study with bilateral SCFE or unilateral SCFE with subsequent contralateral involvement had a BMI-for-age ≥85 % (44 out of 45 patients). Additionally, the overall risk of developing bilateral SCFE until physeal closure with a BMI-for-age ≥95 % was significantly increased (OR 3.84; RR 2.02; p < 0.05; number needed to treat [NNT] 3.01).ConclusionsPrevious work has established a relationship between BMI and SCFE. The CDC BMI-for-age growth charts more accurately measure obesity in the pediatric population compared to BMI and are therefore a more appropriate reference tool. This study demonstrates an association between obesity measured by BMI-for-age percentiles and SCFE. This study also demonstrates an association between BMI-for-age and risk for bilateral SCFE at presentation as well as overall incidence of developing bilateral SCFE in the obese pediatric population. By defining the at-risk population through BMI-for-age, physicians can screen the pediatric patient population and provide early strategies for therapeutic weight loss which may reduce the incidence of SCFE.

Prediction of Contralateral Slipped Capital Femoral Epiphysis Using the Modified Oxford Bone Age Score

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. 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 initial radiographs were given a score ranging from 16 to 26. Statistical analysis was used to determine whether the modified Oxford bone score was predictive of future development of contralateral slip. A linear regression model was used to estimate the probability of future development of a contralateral slip as related to the modified Oxford bone score. Of the 260 patients, 64 (24%) developed a contralateral slip, at an average of 10 months after initial presentation. Race, sex, age, and weight at initial presentation were not predictive of the development of contralateral slip. The modified Oxford score and a triradiate score of 1 were found to be significant (P<0.0001) predictors, with the modified Oxford score a better overall predictor. The modified Oxford bone age score is the best predictor of the risk of development of a contralateral SCFE in patients presenting with a unilateral slip. Controversy exists regarding prophylactic pinning of a normal hip in patients presenting with unilateral SCFE. The benefits of prophylactic pinning must outweigh risk. This study provides probability data for predicting a contralateral slip based on the modified Oxford bone maturity score that can be shared with families and allows physicians to decide their threshold for prophylactically pinning the contralateral hip in patients presenting with a unilateral slip. Therapeutic level IV, Case series.

Slipped capital femoral epiphysis in patients with Down syndrome.

The authors report their experience with eight patients (11 hips) with Down syndrome who sustained a slipped capital femoral epiphysis (SCFE). Six patients were diagnosed with hypothyroidism. All patients were greater than the 85th percentile for body mass index. Initial treatment was by in situ pinning in all hips. Six of the 11 slips progressed, 2 had collapse consistent with avascular necrosis, and 1 developed collapse secondary to joint sepsis and osteomyelitis. Additional surgery was necessary on seven hips. Four of eight hips followed until maturity had substantial femoral head deformity. Three of these patients had a noticeable limp and pain. Treatment of SCFE in patients with Down syndrome is difficult and the prognosis is guarded. These patients should be screened for hypothyroidism.