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Comparative Study
. 2004 Aug;47(4):284-9.

Slipped capital femoral epiphysis: an analysis of treatment outcome according to physeal stability

Salah Fallath  1 , Merv Letts
Affiliations
Comparative Study

Slipped capital femoral epiphysis: an analysis of treatment outcome according to physeal stability

Salah Fallath et al. Can J Surg. 2004 Aug.

Abstract
in English, French

Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. Treatment can be associated with serious complications, mainly avascular necrosis (AVN). The objective of this study was to evaluate treatment outcomes and complications based on physeal stability at presentation.

Methods: We reviewed retrospectively all children treated for SCFE from 1990 through 2000 at the Children's Hospital of Eastern Ontario, Ottawa.

Results: Of a total of 87 patients (56 male) identified, 73 had slips classed as stable and 14, unstable; 42 involved the left side, 34 the right, and 19 were bilateral. Avascular necrosis (AVN) developed in 1 patient with a stable slip (morbidity 1.4%) and in 3 with unstable slips (21.4%; p = 0.001). Manipulative anatomical reduction was done in 11 cases (78.5%), all unstable slips. All slips complicated by AVN had been classified according to the traditional system as acute-on-chronic. Complication rates differed significantly between unstable slips (36%) and stable (20%). No statistically significant association was found between AVN and slip severity, time to fixation or use of reduction.

Conclusions: The treatment of stable slips exhibits a lower incidence of AVN. These results nevertheless suggest that gentle reduction of unstable slips is safe and unaccompanied by an increase in complications.

Introduction: L'épiphysiolyse fémorale supérieure (EFS) est un trouble de la hanche courant chez les adolescents. Le traitement peut être associé à des complications graves, principalement la nécrose avasculaire (NAV). Cette étude visait à évaluer les résultats du traitement et les complications en fonction de la stabilité de l'épiphyse lorsque le patient s'est présenté.

Méthode: Nous avons examiné rétrospectivement tous les enfants traités pour EFS de 1990 à 2000 au Centre hospitalier pour enfants de l'est de l'Ontario, à Ottawa.

Résultats: Sur un total de 87 patients (56 de sexe masculin) identifiés, on avait classé 73 épiphysiolyses comme stables, et 14 instables. Il y en avait 42 du côté du gauche, 34 du côté droit et 19 des deux côtés. La nécrose avasculaire (NAV) a fait son apparition chez un patient dont l'épiphysiolyse était stable (morbidité de 1,4 %) et chez trois où elle était instable (21,4 %; p = 0,001). On a procédé à une réduction anatomique par manipulation chez 11 patients (78,5 %) dont l'épiphysiolyse était stable dans tous les cas. On avait classé toutes les épiphysiolyses qui avaient entraÎné une complication causée par NAV en fonction du système traditionnel, soit aiguë-sur-chronique. Les taux de complication ont différé considérablement entre les épiphysiolyses instables (36 %) et stables (20 %). On n'a pas trouvé de lien statistiquement significatif entre la NAV et la gravité de l'épiphysiolyse, le temps nécessaire à la fixation ou le recours à la réduction.

Conclusions: Le traitement des épiphysiolyses stables produit une incidence plus faible de NAV. Ces résultats indiquent néanmoins que la réduction en douceur des épiphysiolyses instables est sans danger et n'entraÎne pas d'augmentation des complications.

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Figures

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FIG. 1. Radiograph of the hips of a 5-year-old boy with Scheuchmann's syndrome, illustrating widened physis in the anteroposterior view (upper x-ray) and grade I slips bilaterally on the frog-leg view (lower x-ray).
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Figure 1. Continued.
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FIG. 2. Radiographs of a 14-year-old boy with a stable slip. The 2 cannulated screws were changed to 1 screw the day after the first operation because of joint penetration. The radiolucent area involves the anterolateral area of the head on both the anteroposterior (left x-ray) and frog-leg lateral (right x-ray) views.
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Figure 2. Continued.
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FIG. 3. Left, a radiograph of a child with bilateral slipped capital femoral epiphysis, stable on the child's left and unstable on the right, who developed AVN. Right, a radiograph taken after removal of the right screw, 2 years later.
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Figure 3. Continued.
See this image and copyright information in PMC

References

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