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Kennedy GEM, Pullan J, El-Bakoury A. Comparing pinning in situ and capital realignment procedures for severe, stable slipped capital femoral epiphysis: a systematic review. J Hip Preserv Surg 2023; 10:238-243. [PMID: 38162270 PMCID: PMC10757418 DOI: 10.1093/jhps/hnad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/13/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024] Open
Abstract
In severe, stable slipped capital femoral epiphysis, it is unclear whether pinning in situ (PIS) or capital realignment procedures (CRPs) are superior. Our primary aim was to compare patient-reported outcome measures (PROMs) following each strategy. Secondary aims were to compare rates of femoral head avascular necrosis (AVN) and complications. MEDLINE, Embase and Cochrane databases were searched according to an agreed strategy. Narrative review articles, case reports, letters to the editor and articles not written in English were excluded. The risk of bias was assessed using the Newcastle-Ottawa Scale. Of the 132 citations identified, 127 were excluded following de-duplication and application of the exclusion criteria. Three observational studies comparing PIS with CRP and two case series considering CRP alone were identified. One article was considered fair quality, and four articles were considered poor. In total, 198 hips from five studies were included (66 PIS, 132 CRP). PIS was associated with moderate-good functional outcomes, and CRP with good-high outcomes. Two comparative studies reported significantly better PROMs following CRP. AVN was reported in 1.5% following PIS and 10.6% following CRP. Regarding other complications, chondrolysis occurred in 3.0% following PIS and 2.4% following CRP. Femoroacetabular impingement rates were markedly higher following PIS (60.6% versus 2.3%). Reoperation rates were also greater following PIS (34.5% versus 13.3%). PIS tends to be associated with favourable AVN rates, but CRP with favourable PROMs and complication rates. However, comparisons were drawn from heterogeneous studies lacking long-term follow-up. Further high-quality research is required.
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Affiliation(s)
- Grace E M Kennedy
- Department of Trauma and Orthopaedics, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK
| | - Jack Pullan
- Department of Trauma and Orthopaedics, University Hospitals Plymouth, Plymouth PL6 8DH, UK
| | - Ahmed El-Bakoury
- Department of Trauma and Orthopaedics, University Hospitals Plymouth, Plymouth PL6 8DH, UK
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Buchan SJ, Lindisfarne EA, Stabler A, Barry M, Gent ED, Bennet S, Aarvold A. The Free-Gliding screw for slipped capital femoral epiphysis : is it safe, does it glide, and does age matter? Bone Joint J 2023; 105-B:215-219. [PMID: 36722064 DOI: 10.1302/0301-620x.105b2.bjj-2022-0700.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. METHODS All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years' follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein's line were recorded. Subanalysis was performed according to sex and age. RESULTS A total of 19 hips in 13 patients were included. The mean age of the patients at the time of surgery was 11.5 years (9 to 13) and the mean follow-up was 63 months (45 to 83). A total of 13 FG SCFE screws were used for the fixation of mild or moderate SCFE, with six contralateral prophylactic fixations. No hip with SCFE showed a further slip after fixation and there were no complications. Lengthening occurred in 15 hips (79%), with a mean lengthening of the barrel of 6.8 mm (2.5 to 13.6) at final follow-up. Remodelling occurred in all hips with lengthening of the barrel. There was statistically more lengthening in patients who were aged < 12 years, regardless of sex (p = 0.002). CONCLUSION The FG SCFE screw is effective in preventing further slip in patients with SCFE. Lengthening of the barrel occurred in most hips, and thus allowed remodelling. This was most marked in younger children, regardless of sex. Based on this study, this device should be considered for use in patients with SCFE aged < 12 years instead of standard pinning in situ.Cite this article: Bone Joint J 2023;105-B(2):215-219.
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Affiliation(s)
| | | | | | | | - Edward D Gent
- Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Simon Bennet
- Southampton Children's Hospital, Southampton, UK
| | - Alexander Aarvold
- Southampton Children's Hospital, Southampton, UK.,University of Southampton, Southampton, UK
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3
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Avascular Necrosis and Time to Surgery for Unstable Slipped Capital Femoral Epiphysis: A Systematic Review and Meta-analysis. J Pediatr Orthop 2022; 42:545-551. [PMID: 35941089 DOI: 10.1097/bpo.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) is a well-known complication of unstable slipped capital femoral epiphysis (SCFE) and its cause is multifactorial. Higher AVN rates have been reported with surgery undertaken between 24 hours to 7 days from the onset of symptoms. The current evidence regarding time to surgery and AVN rate remains unclear. The aim of our study was to investigate the rate of AVN and time to surgery in unstable SCFE. METHODS A literature search of several databases was conducted. Eligibility criteria included all studies that reported AVN rates and time to surgery in unstable SCFE patients. We performed a meta-analysis using a random-effects model to pool the rate of AVN in unstable SCFE using different time to surgery subgroups (≤24 h, 24 h - 7 d and >7 d). Descriptive, quantitative and qualitative data were extracted. RESULTS Twelve studies matched our eligibility criteria. In total, there were 434 unstable SCFE of which 244 underwent closed reduction (CR). The pooled AVN rates were 24% [95% CI: 16%-35%] and 29% [95% CI: 16%-45%] for the total and CR groups, respectively. The highest AVN rates were with surgery between 24 hours to 7 days, 42% and 54% for the total and CR groups, respectively. The lowest rates of AVN were with time to surgery ≤24 hours (22% and 21% respectively) and >7 days (18% and 29% respectively). These differences were not statistically significant. There was significant subgroup heterogeneity which was highest in the 24 hours - 7 days subgroup and lowest in the >7 days subgroup. CONCLUSIONS The cumulative evidence was not conclusive for an association between AVN rate and time to surgery. The overall AVN rates were lower in unstable SCFE patients who had surgery ≤24 hours and >7 days. However, treatment techniques were very variable and there was significant heterogeneity in the included studies. Multi-centre prospective studies are required with well-defined time to surgery outcomes. LEVEL OF EVIDENCE Level III/IV.
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Veramuthu V, Munajat I, Islam MA, Mohd EF, Sulaiman AR. Prevalence of Avascular Necrosis Following Surgical Treatments in Unstable Slipped Capital Femoral Epiphysis (SCFE): A Systematic Review and Meta-Analysis. CHILDREN 2022; 9:children9091374. [PMID: 36138683 PMCID: PMC9497816 DOI: 10.3390/children9091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
The choice of treatment for unstable and severely displaced slipped capital femoral epiphysis (SCFE) is controversial. This meta-analysis was conducted to determine the prevalence of femoral head avascular necrosis (AVN) following various treatments for unstable SCFE. Various databases were searched to identify articles published until 4 February 2022. A random-effects model was used to examine prevalence as well as risk ratios with confidence intervals (CIs) of 95%. Thirty-three articles were analyzed in this study. The pooled prevalences of AVN in pinning in situ, pinning following intentional closed reduction, pinning following unintentional closed reduction, and open reduction via the Parsch method, subcapital osteotomy and the modified Dunn procedure were 18.5%, 23.0%, 27.6%, 9.9%, 18.6% and 19.9%, respectively. The risk of developing AVN in pinning following intentional closed reduction was found to be 1.62 times higher than pinning in situ; however, this result was not significant. The prevalence of AVN in open reduction was lowest when performed via the Parsch method; however, this finding should be interpreted with caution, since the majority of slips so-treated are of mild and moderate types as compared with the subcapital osteotomy and modified Dunn procedures, which are predominantly used to treat severely displaced slips. As the risk ratio between intentional closed reduction and the modified Dunn method showed no significant difference, we believe that the modified Dunn method has the advantage of meticulously preserving periosteal blood flow to the epiphysis, thus minimizing AVN risk. In comparison with intentional closed reduction, the modified Dunn method is used predominantly in cases of severe slips.
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Affiliation(s)
- Vijayanagan Veramuthu
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Munajat
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (I.M.); or (M.A.I.)
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence: (I.M.); or (M.A.I.)
| | - Emil Fazliq Mohd
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Abdul Razak Sulaiman
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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5
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A Retrospective Study of Risk Factors and Outcomes in the Surgical Management of Slipped Capital Femoral Epiphysis. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202207000-00001. [PMID: 35794815 PMCID: PMC9263461 DOI: 10.5435/jaaosglobal-d-21-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
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Perry DC, Arch B, Appelbe D, Francis P, Craven J, Monsell FP, Williamson P, Knight M. The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain. Bone Joint J 2022; 104-B:519-528. [PMID: 35360942 PMCID: PMC9020520 DOI: 10.1302/0301-620x.104b4.bjj-2021-1709.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE). METHODS This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. RESULTS A total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define 'at risk'. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE. CONCLUSION The experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials. Cite this article: Bone Joint J 2022;104-B(4):519-528.
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Affiliation(s)
- Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Trauma and Orthopaedics Department, Alder Hey Children's Hospital, Liverpool, UK.,Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Barbara Arch
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Duncan Appelbe
- Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Priya Francis
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joanna Craven
- North West School of Surgery, Health Education England, Liverpool, UK
| | | | - Paula Williamson
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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7
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Daley E, Zaltz I. Strategies to Avoid Osteonecrosis in Unstable Slipped Capital Femoral Epiphysis: A Critical Analysis Review. JBJS Rev 2020; 7:e7. [PMID: 31021894 DOI: 10.2106/jbjs.rvw.18.00129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erika Daley
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan
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8
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Fernandez FF, Eberhardt O, Wirth T. [Early and late complications and their management in slipped capital femoral epiphysis]. DER ORTHOPADE 2019; 48:677-684. [PMID: 31025044 DOI: 10.1007/s00132-019-03729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) remains a challenge for the treating surgeon. First of all, SCFE should be diagnosed as early as possible. The earlier the diagnosis is made in adolescents, the lower the slip angle will be. Mild slips show more favourable long-term courses than moderate and severe SCFE. COMPLICATIONS With increasing slip angle, the risk of complications increases. The complications of SCFE are diverse, the most severe of which are avascular necrosis (AVN) and chondrolysis. AVN is more common in surgically treated than in non-operatively managed patients and unstable SCFE bears the highest risk of AVN. THERAPY Adequate treatment of AVN is still controversial. For surgical treatments, variable rates of AVN have been reported. There is a wide spectrum of surgeries for treating AVN, from hip joint-preserving techniques to total hip replacement. In central Europe there is wide consensus in favour of treating the contralateral side, but this is not without complications. Surgical treatment with in-situ pinning must be carried out with great care to take into consideration the morphology of the femoral head and not to perforate it. It should always be ensured that no osteosynthesis material penetrates the hip joint.
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Affiliation(s)
- F F Fernandez
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland.
| | - O Eberhardt
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
| | - T Wirth
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
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9
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Kaushal N, Chen C, Agarwal KN, Schrader T, Kelly D, Dodwell ER. Capsulotomy in Unstable Slipped Capital Femoral Epiphysis and the Odds of AVN: A Meta-analysis of Retrospective Studies. J Pediatr Orthop 2019; 39:e406-e411. [PMID: 30994581 DOI: 10.1097/bpo.0000000000001359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unstable slipped capital femoral epiphysis (SCFE) may lead to avascular necrosis (AVN) in up to 60% of patients. The aim of this study was to assess the best clinical evidence to determine the effect of capsular decompression (CD) on odds of AVN in unstable SCFE. METHODS Medline, Embase, and Cochrane databases were systematically searched for comparative studies investigating AVN rates in unstable SCFE treated with or without CD (aspiration, percutaneous, or open). Quality was evaluated by the Newcastle Ottawa Scale. A comparative analysis with pooled effect estimates using random-effects modeling was calculated. Secondary analysis pooled AVN rates from both comparative studies and case series. RESULTS Comparative analysis included 17 retrospective studies with 453 hips (201 with CD, 252 without CD). Thirty-four of 201 (17%) hips with CD developed AVN, while 67 of 252 (27%) hips without CD developed AVN. The odds of AVN for patients treated with or without CD [odds ratio=0.80, 95% confidence interval (CI): 0.48-1.35] was not statistically different. Subanalysis on patients treated with in situ pinning or positional reduction and pinning showed no difference in AVN rates with or without CD (odds ratio=0.97, 95% CI: 0.44-2.10). In the secondary analysis of 17 comparative studies and 23 case series, the average rate of AVN was 17%, 0.17 (95% CI: 0.13-0.23) for patients treated with CD (60/447 hips) and 28%, 0.28 (95% CI: 0.22-0.35) for patients treated without CD (129/464 hips). CONCLUSIONS There was no statistically significant decrease in odds of AVN with CD. However, studies were limited by their retrospective nature and inadequate documentation of CD techniques; the majority lacked femoral head blood flow monitoring to demonstrate adequate decompression. Future prospective studies with carefully documented complete decompression may help to elucidate the effect of CD on AVN risk. Although there was no statistically different odds of AVN with or without CD, even this large meta-analysis was underpowered, and one cannot conclude that there was truly no difference in odds of AVN without an appropriately powered study. Therefore, we recommend routine CD for all unstable SCFEs pending additional research, as CD adds little to the surgical procedure and may minimize the risk of a devastating insult to the femoral head.
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Affiliation(s)
| | - Cynthia Chen
- New York Presbyterian, Columbia University Irving Medical Center
| | | | - Tim Schrader
- Children's Healthcare of Atlanta, CPG-Orthopaedics, Atlanta, GA
| | - Derek Kelly
- Campbell Clinic Orthopedics and University of Tennessee Department of Orthopedics and Biomechanics, Collierville, TN
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10
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Intracapsular cuneiform osteotomy compared with in-situ pinning for the management of slipped capital femoral epiphysis. J Pediatr Orthop B 2018; 27:491-495. [PMID: 29878978 DOI: 10.1097/bpb.0000000000000530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intracapsular cuneiform osteotomy was initially introduced to restore the morphology of the proximal femur after slipped capital femoral epiphysis (SCFE). However, whether this procedure results in a higher risk of avascular necrosis (AVN) or lower incidence of cam deformity than in-situ pinning is unclear. The aim of this study was to compare the outcomes of intracapsular cuneiform osteotomy and in-situ pinning to treat SCFE in children. Twenty-three children who suffered from SCFE underwent either intracapsular cuneiform osteotomy (eight patients, eight hips) or in-situ pinning (15 patients, 18 hips) between 2006 and 2014. No patient was lost to follow-up at a mean of 4.5 years. In the osteotomy group, the Japanese Orthopedic Association's hip score system score increased from 50.5 (20-89) to 98.9 (95-100) and from 65.9 (48-90) to 99.0 (44-100) in the in-situ pinning group. On the basis of the slip angle, α angle, and epiphyseal-metaphyseal offset, intracapsular cuneiform osteotomy showed a significantly better result in restoring the morphology of the proximal femur than in-situ pinning (P<0.001). The incidences of AVN, chondrolysis, and lower limb discrepancy were similar between the two groups. On the basis of clinical outcomes, both intracapsular cuneiform osteotomy and in-situ pinning had acceptable abilities to treat SCFE. The incidence of AVN was not related to which technique was used. Osteotomy significantly restored the morphology of the proximal femur.
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Subcapital Shortening Osteotomy for Severe Slipped Capital Femoral Epiphysis: Preliminary Results of the French Multicenter Study. J Pediatr Orthop 2018; 38:471-477. [PMID: 27603189 DOI: 10.1097/bpo.0000000000000854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is growing evidence that symptomatic femoroacetabular impingement (FAI) can develop after severe slipped capital femoral epiphysis (SCFE) fixed in situ. Realignment procedures have therefore gained popularity, but complication rates remain controversial. Among them, the subcapital shortening osteotomy without hip dislocation has been progressively adopted in France, but results have never been assessed to date. METHODS All cases performed in 23 French university hospitals between January 2010 and March 2014 were reviewed to (1) describe the surgical procedure, (2) assess the radiologic and functional outcomes, and (3) report complications and more specifically the avascular necrosis rate (AVN) according to initial stability. Stable and unstable SCFE were distinguished following Loder's definition. Radiologic outcomes were assessed by the 3 authors to determine FAI and osteonecrosis rates. Functional outcomes were evaluated at follow-up and complications were reported. RESULTS A total of 82 cases (45 unstable and 37 stable), performed in 10 institutions, were included with a mean follow-up of 25 months. No intraoperative complication occurred but 2 patients (2.4%) underwent unplanned early revision. Slip angle was significantly reduced (87%) without loss of correction. Overall AVN rate was 9.7%, reaching 13.3% in unstable slips. However, preoperative magnetic resonance imaging showed that most of the unstable epiphyses (4/6) were already hypoperfused before surgery. CONCLUSIONS The procedure is a reliable option for the treatment of severe SCFE. AVN rates are lower than previously reported in multicenter series of modified Dunn technique, especially in unstable slips. However, the risk of AVN in severe stable SCFE (5.4%) must still be balanced with the functional outcomes of potential future FAI. LEVEL OF EVIDENCE Level IV-therapeutic study.
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12
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Kohno Y, Nakashima Y, Kitano T, Irie T, Kita A, Nakamura T, Endo H, Fujii Y, Kuroda T, Mitani S, Kitoh H, Matsushita M, Hattori T, Iwata K, Iwamoto Y. Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study. J Orthop Sci 2017; 22:112-115. [PMID: 27629912 DOI: 10.1016/j.jos.2016.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an "unsafe window", during which medical interventions would increase the risk for AVN. METHODS This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014. Timing of surgery was evaluated for three time periods, from acute onset of symptoms to surgery: period I, <24 h; period II, between 24 h and 7 days; and period III, >7 days. Multivariate logistic regression analysis was used to identify risk factors for AVN. RESULTS Closed reduction and pinning was performed in 43 patients and in situ pinning in 17. Among these cases, 16 patients (27%) developed AVN. The rate of AVN was significantly higher in patients treated by closed reduction and pinning (15/43, 35%) than in those treated by in situ pinning (1/17, 5.9%) (p = 0.022). In patients treated by closed reduction and pinning, the incidence of AVN was 2/11 (18%) in period I, 10/13 (77%) in period II and 3/15 (20%) in period III, showing the significantly higher rate in period II (p = 0.002). The surgery provided in period II was identified as an independent risk factor for the development of AVN. CONCLUSIONS Our rate of AVN was 27% using two classical treatment methods. Time-to-surgery, between 24 h and 7 days, was independently associated with AVN, supporting the possible existence of an "unsafe window" in patients with unstable SCFE treated by closed reduction and pinning.
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Affiliation(s)
- Yusuke Kohno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Toshio Kitano
- Department of Pediatric Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Taichi Irie
- Department of Orthopaedic Surgery, Sendai City Hospital, Sendai, Japan
| | - Atsushi Kita
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, Sendai, Japan
| | - Tomoyuki Nakamura
- Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Yosuke Fujii
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Takayuki Kuroda
- Department of Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shigeru Mitani
- Department of Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Nagoya University, Nagoya, Japan
| | | | - Tadashi Hattori
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Japan
| | - Koji Iwata
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Vanhegan IS, Cashman JP, Buddhdev P, Hashemi-Nejad A. Outcomes following subcapital osteotomy for severe slipped upper femoral epiphysis. Bone Joint J 2016; 97-B:1718-25. [PMID: 26637690 DOI: 10.1302/0301-620x.97b12.35259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Slipped upper femoral epiphysis (SUFE) is the most common hip disorder to affect adolescents. Controversy exists over the optimal treatment of severe slips, with a continuing debate between in situ fixation versus corrective surgery. We present our experience in a series of 57 patients presenting with severe unilateral SUFE (defined > 50°) managed with a subcapital cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to our tertiary referral institution with a severe slip. The affected limb was rested in slings and springs before corrective surgery which was performed via an anterior Smith-Petersen approach. Radiographic analysis confirmed an improvement in mean head-shaft slip angle from 53.8(°) (standard deviation (SD) 3.2) pre-operatively to 9.1(°) (SD 3.1) post-operatively, with minimal associated femoral neck shortening. In total 50 (88%) patients were complication free at a mean follow-up of seven years (2.8 to 13.9 years, SD 3). Their mean Oxford hip score was 44 (37 to 48) and median visual analogue pain score was 0 out of 10 (interquartile range 0 to 4). A total of six patients (10.5%) developed avascular necrosis requiring further surgery and one (1.8%) patient developed chondrolysis but declined further intervention. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results in our tertiary centre.
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Affiliation(s)
- I S Vanhegan
- Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
| | - J P Cashman
- Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
| | - P Buddhdev
- Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - A Hashemi-Nejad
- Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
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14
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Abstract
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.
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15
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Chandrakar D, Kaur J, Dubey V, Suryanarayana NS, Parganiha Y. Infrared and visible emissions of rare-earth-doped CeO2phosphor. LUMINESCENCE 2015; 30:1201-6. [DOI: 10.1002/bio.2881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/01/2014] [Accepted: 01/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- D. Chandrakar
- Govt. V.Y.T.PG. Autonomous College Durg; Physics Durg; Chhattisgarh 491001 India
| | - J. Kaur
- Govt. V.Y.T.PG. Autonomous College Durg; Physics Durg; Chhattisgarh 491001 India
| | - V. Dubey
- Govt. V.Y.T.PG. Autonomous College Durg; Physics Durg; Chhattisgarh 491001 India
| | - N. S. Suryanarayana
- Govt. V.Y.T.PG. Autonomous College Durg; Physics Durg; Chhattisgarh 491001 India
| | - Y. Parganiha
- Govt. V.Y.T.PG. Autonomous College Durg; Physics Durg; Chhattisgarh 491001 India
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