- Discussion:
-
acute slip:
-
acute on chronic slip:
-
chronic slip:
- treatment of is designed to fuse epiphysis on femoral neck which prevents further slipping;
- this usually involves insertion of one or more screws into anterior aspect of
greater trochanter or femoral neck (depending on degree of
slip) to enter center of epiphysis;
- this is achieved w/ care to avoid penetration into the hip joint which can lead to
chondrolysis and care to avoid
manipulation (in chronic or acute on chronic cases) which may cause osteonecrosis;
-
rule out bilateral SCFE:
- before proceding on with screw fixation of the "injured side", be sure that the "uninjured side" does not have a subacute slip (w/ a
frog leg lateral as well as an AP of the pelvis);
- Surgical Considerations:
-
timing:
-
reduction vs in situ pinning
-
screw placement and number of screws:
-
pinning of the contralateral hip:
- Remodeling:
- whether or not remodeling occurs following treatment of SCFE, ROM and gait improve, allowing most patients to have acceptable function;
- rather than actual remodeling, some believe that there is resorption of bone on anterolateral aspect of neck of femur, resolution of muscle spasm &
- references:
- Physeal remodeling
after internal fixation of slipped capital femoral epiphyses.
- Remodeling
of the femoral neck after in situ pinning for slipped capital femoral epiphysis.
-
Clinical outcome and assessment of spontaneous remodeling of slipping angle in SCFE.
-
Remodeling after in situ pinning for slipped capital femoral epiphysis.
- References for SCFE:
Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership.
Intra-operative arthrography facilitates accurate screw fixation of a slipped capital femoral epiphysis.
Slipped capital femoral epiphysis in skeletally immature patients.
Slipped capital femoral epiphysis in skeletally immature patients.
Pinning in slipped capital femoral epiphysis: long-term follow-up study.
Valgus slipped capital femoral epiphysis.
Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.
