Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts 16 articles

Articles

Patients With Unstable Slipped Capital Femoral Epiphysis Have Antecedent Symptoms

Thomas G. McPartland MD, Wudbhav N. Sankar MD, Young-Jo Kim MD, PhD, Michael B. Millis MD

The characteristics of patients who sustain unstable slipped capital femoral epiphyses (SCFEs) are not well described compared to their counterparts who sustain stable SCFE. Although patients with unstable slips are usually identified owing to acute symptoms, it is unclear whether these patients have premonitory symptoms that could heighten the awareness of treating physicians to the possibility of an unstable slip and lead to timely diagnosis and treatment.

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

George H. Thompson MD, Ethan S. Lea MD, MS, Kenneth Chin MD, Raymond W. Liu MD, Jochen P. Son-Hing MD, Allison Gilmore MD

Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression.

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Kai Ziebarth MD, Michael Leunig MD, Theddy Slongo MD, Young-Jo Kim MD, PhD, Reinhold Ganz MD

Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation.

Postoperative Improvement of Femoroacetabular Impingement After Intertrochanteric Flexion Osteotomy for SCFE

Takashi Saisu MD, PhD, Makoto Kamegaya MD, PhD, Yuko Segawa MD, PhD, Jun Kakizaki MD, Kazuhisa Takahashi MD, PhD

Patients with slipped capital femoral epiphysis (SCFE) may develop cam-type femoroacetabular impingement (FAI). Early management of FAI has been advocated for patients with symptomatic FAI. The various treatment options, including reorientation surgeries, realignment procedures, and osteoplasty, remain controversial.

Symptomatic Femoroacetabular Impingement: Does the Offset Decrease Correlate With Cartilage Damage? A Pilot Study

Christoph Zilkens MD, Falk Miese MD, Rüdiger Krauspe MD, Bernd Bittersohl MD

Current measures of the reduced head-neck offset such as residual deformity of slipped capital femoral epiphysis (SCFE) including the alpha angle, which measures the femoral head-neck sphericity but does not account for acetabular abnormalities, do not represent the true magnitude of the deformity and the mechanical consequences. The beta angle (angle between the femoral head-neck junction and acetabular rim) accounts for the morphology of both the acetabulum and femur and, thus, may be the more appropriate parameter for assessing SCFE deformity.

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

Adam Y. Nasreddine MA, Benton E. Heyworth MD, David Zurakowski PhD, Mininder S. Kocher MD, MPH

Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE.

Increased Acetabular Depth May Influence Physeal Stability in Slipped Capital Femoral Epiphysis

David A. Podeszwa MD, David Gurd MD, Anthony Riccio MD, Adriana Rocha MS, Daniel J. Sucato MD, MS

Multiple mechanical factors affecting the hip have been associated with the development of slipped capital femoral epiphysis (SCFE). Whether acetabular depth plays a role in the development of a SCFE has not been elucidated.

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Todd Bertrand MD, James R. Urbaniak MD, Robert K. Lark MD, MS

Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3–60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head.

Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

Ira Zaltz MD, Geneva Baca PhD, John C. Clohisy MD

The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques.

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Yaser M. K. Baghdadi MD, A. Noelle Larson MD, Rafael J. Sierra MD, Hamlet A. Peterson MD, Anthony A. Stans MD

The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear.

Case Reports: Acetabular Damage After Mild Slipped Capital Femoral Epiphysis

Cara Beth Lee MD, Travis Matheney MD, Yi-Meng Yen MD, PhD

Slipped capital femoral epiphysis (SCFE) is a common hip problem in adolescents that results in a cam-type femoroacetabular impingement (FAI) deformity. Although the treatment for mild (slip angle of 0°–30°) and moderate (slip angle of 31°–60°) SCFE has historically been in situ fixation, recent studies have demonstrated impingement-related articular damage, irrespective of slip severity. Our series confirms previous reports that acetabular chondral injury occurs in mild to low-moderate (slip angle of ≤ 40°) SCFE.

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Shafagh Monazzam MD, Venkatadass Krishnamoorthy MD, Bernd Bittersohl MD, James D. Bomar MPH, Harish S. Hosalkar MD

Recent biplanar radiographic studies have demonstrated acetabular retroversion and increased superolateral femoral head coverage in hips with slipped capital femoral epiphysis (SCFE), seemingly divergent from earlier CT-based studies suggesting normal acetabular version.

What Are the Risks of Prophylactic Pinning to Prevent Contralateral Slipped Capital Femoral Epiphysis?

Wudbhav N. Sankar MD, Eduardo N. Novais MD, Christopher Lee MD, Ali A. Al-Omari MD, Paul D. Choi MD, Benjamin J. Shore MD, FRCSC

Two decision analyses on managing the contralateral, unaffected hip after unilateral slipped capital femoral epiphysis (SCFE) have failed to yield consistent recommendations. Missing from both, however, are sufficient data on the risks associated with prophylactic pinning using modern surgical techniques.