Osteonecrosis After Contralateral in Situ Prophylactic Pinning for a Slipped Capital Femoral Epiphysis: A Case Report

Fix it or risk it? Revisiting contralateral hip prophylactic fixation in unilateral slipped capital femoral epiphysis: an updated review of the past decade's literature

Slipped capital femoral epiphysis (SCFE) is a common hip pathology occurring in pediatrics and adolescents, and its management is well documented in the literature regardless of its severity. In patients presenting with unilateral SCFE, the incidence of subsequent contralateral slip (SCS) is variable among studies, and the issue of contralateral hip prophylactic fixation (CHPF) becomes a concern. The fundamental rationale behind performing CHPF is to avoid the subsequent contralateral slip, which consequently lowers the risk of femoral head avascular necrosis and chondrolysis. However, prophylactic fixation carries the risk of altering proximal femoral growth, peri-implant fractures, and requiring secondary surgery for hardware removal. The current review was formulated based on the literature published in the last decade and aimed to evaluate the incidence of SCS and indications for CHPF. Apart from institutions' protocol or individual surgeons' preferences, various variables were suggested to justify CHPF, including patient-related variables such as the presence of endocrinopathy, those younger than 13 years old (10-13), and patients with mOBAS ≤ 20. Radiological parameters, posterior slip angle ≥ 14.5°, positive crossover sign, posterior epiphyseal tilt of ≥ 10°, alpha angle of ≥ 49°, and a Probability analysis of sequential SCFE (PASS score) of ≥ 3. However, there is still a controversy in the literature regarding CHPF performance and which parameter is highly dependable for predicting the SCS. The controversy extends to the effect and efficacy of various fixation hardware and whether keeping patients under observation is less effective than CHPF. Furthermore, well-designed randomized controlled trials are lacking, and their performance is warranted to establish clear indications for performing CHPF and to clarify its safety, possible consequences, and cost-effectiveness.

[Osteonecrosis of the femoral head complicating prophylactic screw fixation for upper femoral epiphyolysis: case report and literature review]

L’attitude thérapeutique à adopter sur la hanche radiologiquement «normale» d’un enfant présentant une épiphysiolyse fémorale supérieure sur la hanche controlatérale, reste controversée. Nous rapportons le cas d’un jeune adolescent de 12 ans qui a développé une ostéonécrose de la tête fémorale radiologiquement «normale» et asymptomatique, sur la hanche gauche qui a été fixée de façon prophylactique dans le cadre d’une épiphysiolyse fémorale aigue survenue sur la hanche controlatérale. Huit mois après la première chirurgie, le patient a développé des signes d’ostéonécrose avasculaire de la tête fémorale. Des critères spécifiques existent pour permettre de poser l’indication d’un vissage préventif ou d’une simple surveillance rapprochée. Malgré ces critères le risque de survenue d’ostéonécrose sur la hanche «saine», n’est pas nul.