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. 2016 Dec;10(6):643-650.
doi: 10.1007/s11832-016-0793-x. Epub 2016 Nov 5.

Continued growth after fixation of slipped capital femoral epiphysis

Per Holmdahl  1   2 , Torsten Backteman  2   3 , Aina Danielsson  2   4 , Johan Kärrholm  2   4 , Jacques Riad  5   6
Affiliations

Continued growth after fixation of slipped capital femoral epiphysis

Per Holmdahl et al. J Child Orthop. 2016 Dec.

Abstract

Purpose: When treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE.

Methods: Sixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4-15.7 years), were included. The slipped hip was fixed with a smooth pin with a hook, and the non-slipped hip was prophylactically pinned. At the time of surgery, tantalum markers were installed bilaterally on each side of the growth plate through the drilled hole for the pin. Examination with radiostereometric analysis (RSA) was performed postoperatively and at 3, 6 and 12 months. The position of the epiphysis in relation to the metaphysis was calculated.

Results: At 12 months, the epiphysis moved caudally, median 0.16 mm and posteriorly 2.28 mm on the slipped side, in comparison to 2.28 cranially and 0.91 mm posteriorly on the non-slipped side, p = 0.003 and p = 0.030, respectively. Both slipped and non-slipped epiphysis moved medially, 1.52 and 1.74 mm, respectively. A marked variation in the movement was noted, especially on the slipped side.

Conclusions: The epiphysis moved in relation to the metaphysis after smooth pin fixation, both on the slipped side and on the prophylactically fixed non-slipped side, implying further growth. The RSA method can be used to understand remodelling after 'growth-sparing' fixation of SCFE.

Keywords: Growth; Impingement; Osteoarthritis; Radiostereometric analysis; Remodelling; Slipped capital femoral epiphysis.

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Conflict of interest statement

Compliance with ethical standardsEthical approvalEthical approval was obtained from the National Ethical Committee.Conflict of interestNo conflicts of interest to declare from any of the authors Per Holmdahl, Torsten Backteman, Aina Danielsson, Johan Kärrholm or Jacques Riad.FundingSource of funding was from the Skaraborg Hospital Research funding (FoU). No funding was received for this work from any of the following organisations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Figures

Fig. 1
Fig. 1
Postoperative frontal and sagittal view, with tantalum markers inserted as well as the smooth hook pin (Hansson) on the slipped side
Fig. 2
Fig. 2
a Movement (in mm) on the slipped and non-slipped sides for each individual and the median (black dotted line) in the medial/lateral direction. n = 16. b Movement (in mm) on the slipped and non-slipped sides for each individual and the median (black dotted line) in the cranial/caudal direction. n = 16. c Movement (in mm) on the slipped and non-slipped sides for each individual and the median (black dotted line) in the anterior/posterior direction. n = 16
Fig. 3
Fig. 3
Radiograph immediately postoperative (a) and 3.4 years later (b), at skeletal maturity. Continued growth and remodelling can be detected, but it is difficult to define and quantify
See this image and copyright information in PMC

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