Slipped capital femoral epiphysis

Slippage of the capital femoral epiphysis typically presents as hip pain in a child. Radiographic examination demonstrates translocation of the upper femoral epiphysis away from its normal anatomic position on the neck of the femur. Slipped capital femoral epiphysis can result in permanent deformity if it is not promptly corrected. Closed pinning is the treatment for acute slips, but treatment options are complex when the condition is chronic.     

Slipped capital femoral epiphysis associated with Russell-Silver syndrome

Slipped capital femoral epiphysis has been described in several syndromes associated with short stature and endocrine disturbances. I have presented a case of slipped capital femoral epiphysis in conjunction with Russell-Silver syndrome.     

Slipped capital femoral epiphysis in identical twins - a case report

Background. The pathoetiology of slipped capital femoral epiphysis (SCFE) has not been thoroughly established. Hormonal and genetic causes are the primary theories under discussion. There are some publications considering the occurrence of SCFE in identical twins. Material and methods. 15-year-old identical twins were admitted to our Department complaining of pain in the left groin and limping. A-P and axial x-rays presented slippage of the left capital femoral epiphysis. Results. Reposition and Kirschner pin fixation were performed in both patients with good clinical outcome. The follow-up period was 4 years. Conclusions. When SCFE occurs in one of a pair of identical twins it is prudent to take the second child under careful observation.     

Anatomical analysis and preoperative planning of correctional osteotomies: Slipped capital femoral epiphysis (SCFE)

Summary

SCFE is defined as the slippage of the femoral head relative to the femoral neck along the proximal femoral growth plate. The femoral head shifts and rotates along the proximal end of the femoral neck, usually posteriorly and interiorly. The pathoanatomical findings are characterised by the changed relationship between the femoral head and femoral metaphysis, and between the femoral head and the acetabulum. A reduced femoral anteversion, a varus deformity of the femur, a shortening of the femoral metaphysis and an anterior metaphyseal prominence are also regularly observed. This may lead to impingement between the femoral metaphysis and the acetabular rim. Potential consequences of this complex 3D deformity are pain, a reduced range of hip motion and an early degenerative joint disease. In moderate and severe cases a redirectional femoral osteotomy is recommended. Different techniques, such as subcapital, base-of-neck, intertrochanteric and subtrochanteric osteotomies, have been described. These correctional osteotomies aim towards a reconstruction of the hip joint geometry, to prevent early arthritic degeneration. Currently, the planning of surgical treatment in these cases is based on measurements on antero—posterior and lateral plain radiographs. The relevant angle for planning of correctional osteotomies is the physis-shaft angle, determined in both plains. These angles describe the degree of slippage, thereby helping the surgeon to indicate and plan a correctional osteotomy. However, plain radiographs are projectional images and therefore carry inaccuracies caused by the overlay of anatomical structures and an incorrect positioning of the patient. 3D reconstructions are more accurate and provide substantial additional information for the surgeon, such as, for example, the anteversion of the acetabulum. We have developed interactive 3D software to measure projected angles, to analyse the geometry of the proximal femur and to determine the orientation of the acetabulum based on 3D reconstructions of CT data-sets. A program was also developed to simulate different techniques of osteotomies and to evaluate the postoperative range of hip motion and the hip-joint geometry. Accurate 3D measurements, additional anatomical information, simulations of different techniques of osteotomies and the evaluation of simulated postoperative results enables the surgeon to determine the best surgical treatment, based on the clinical findings.     

Acute slipped capital femoral epiphysis.

Of 12 cases of acute slipping of the capital femoral epiphysis (representing 11 patients), results were satisfactory in nine cases and poor in three cases at follow-up (in two of the three cases with poor results, reduction was lost postoperatively). Five of nine patients with prodromal symptoms were seen by a physician but were undiagnosed or untreated before the acute slipping. An additional patient had roentgenographic evidence of an early (asymptomatic) slipping capital femoral epiphysis one year before the acute slipping. Preferred treatment is gentle manipulation and fixation with multiple threaded pins, followed by crutch walking for three to four months. Spica casting is not recommended because of an increased incidence of acute articular cartilage necrosis and the possibility of late recurrence of slipping.     

Slipped capital femoral epiphysis,fixation by single screw in situ: A kinematic and radiographic study

Background

Slipped capital femoral epiphysis is known to produce characteristic deformities in the proximal femur, which affect hip motion and may cause a limp. This paper assessed the 3D gait kinematics in adolescents after single screw fixation of moderate to severe, stable, unilateral slipped capital femoral epiphysis. Our goals were to characterize the 3D kinematic patterns and to investigate the correlation between the severity of radiological deformity and severity of gait disturbance.

Methods

This was a retrospective study of patients seen at our institution between 2000 and 2009. Antero–posterior and frog lateral X-rays were reviewed to measure: Southwick's lateral slip angle, the alpha angle of Notzli and Klein's line offset. Quantitative 3D gait data was collected using a state of the art motion capture system. Kinematic waveforms were compared using a functional data analysis version of the t-test.

Findings

There were 30 patients with an average age at pinning of 13 y (10–17 y). Mean gait profile scores were significantly abnormal for slipped side (10.8°) versus sound side (6.8°), slipped side versus normal (5.6°) and sound side versus normal. There was little statistically significant correlation between severity of radiographic deformity and degree of gait disturbance.

Interpretation

Major kinematic pattern deviations could be associated with (a) morphology of the proximal femur and potential femoral acetabular impingement problems and (b) leg length discrepancy. Gait analysis was able to quantify the kinematic deviations due to the anatomical deformities.     

Orthopedic pitfalls in the ED: slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE), though a relatively common disorder, is frequently missed on initial presentation. Symptoms can be vague, the physical examination unrevealing, and radiographic abnormalities subtle. Prompt diagnosis of SCFE is important, however, to improve clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician in the treatment of SCFE.     

Missed slipped capital femoral epiphysis: Illustrative cases and a review

Slipped capital femoral epiphysis (SCFE) is a fairly common condition affecting older children and adolescents, and has the potential for long-term, crippling sequelae. Early recognition is the single most important controllable factor, but the diagnosis is often missed or delayed, resulting in progression of the slip. A SCFE should be suspected and promptly evaluated in any older child or adolescent presenting with a limp or complaints of hip, groin, thigh, or knee pain, especially if the patient is overweight. The diagnosis is usually made by anteroposterior and frog-leg lateral radiographs of the hips. Common errors at initial presentation include: not obtaining hip radiographs (due to either no hip pain or the lack of an impressive history and physical findings); misreading hip radiographs (the findings can be subtle); and lack of timely referral. Early involvement of and treatment by an orthopedic surgeon can greatly reduce the potential complications. We present three cases of SCFE that highlight common errors made at initial presentation, and a discussion that includes the differential diagnosis of an older child or adolescent with a painful limp.     

可恢复性股骨头骨骺缺血的MR实验研究

目的确定通过髋关节极度外展固定的方法能够引起股骨头骨骺的缺血,明确在持续固定多长时间内这种缺血是可恢复性的。方法11头出生3~7周的乳猪,双侧髋关节被极度外展固定。持续固定3~72h以后,对11头乳猪的22个髋关节进行MR扫描,主要扫描序列为Gd增强SE T1WI。扫描完成后1~7天内允许乳猪自由行走,然后再行扫描。分析股骨头骨骺软骨、生长板软骨和二次骨化中心的增强MR表现特征,进行MR表现与组织学发现的比较对照研究。结果在Gd增强MRI,全部22个股骨头的17个骨骺软骨、8个生长板可见局限性的弱强化或未强化。自由行走1天以后,仅1头可见缺血的完全恢复,另10头7天后才显示缺血完全恢复。结论在72h内持续性地髋关节极度外展所引起的股骨头骨骺早期缺血是可恢复的,Gd增强MRI能够检出这种早期可恢复性的缺血。     

34例牵引加原位空心钉固定治疗儿童股骨头骺滑脱的护理

总结了34例牵引加原位空心钉固定治疗儿童股骨头骺滑脱的护理经验。患儿术前均进行牵引,手术采用原位空心钉固定治疗,在对患儿进行系统评估的基础上,对其进行皮肤护理、饮食护理、体位护理、心理护理及功能锻炼指导。本组患儿除3例牵引无效,其余均达到比较满意的复位。     

缺血再灌注损伤对幼兔股骨头骨骺的影响

目的:建立幼兔股骨头骨骺缺血再灌注损伤的动物模型,观察缺血再灌注损伤对幼兔股骨头骨骺的影响。方法:实验于2003-06/2004-02在解放军总医院骨科实验室及病理科实验室完成。取1月龄左右健康新西兰兔48只,体质量(1.0±0.25)kg,雌雄不拘。正常组3只,其余45只采用完全随机的方法分为缺血4,8,12h组,每组15只兔。采用髂总动脉阻断-开放法建立幼兔股骨头骨骺缺血再灌注模型。分离髂总动脉,在两侧髂总动脉分叉处以下用无创血管夹夹闭左侧髂总动脉,到达再灌注时间点后松开血管夹,分别记录缺血和再灌注时间。3组分别在缺血4,8,12h再灌注,每组在再灌注后即刻,4,24,72,168h分批麻醉下处死实验新西兰兔,每组每个时间点3只,正常组在实验条件下即刻处死动物取标本。实验中标本均取自实验侧。将标本分为2份,苏木精-伊红染色观察缺血再灌注后股骨头骨骺的病理组织学结构改变;原位末端标记技术观察缺血再灌注后股骨头骨骺细胞在分子生物学水平上的改变。结果:缺血8h组有1只兔死亡。缺血12h组2只兔死亡,1只兔1周后出现局部肢体缺血性坏死,原因不明,予以剔除并及时补充,进入结果分析48只。①缺血再灌注后幼兔股骨头骨骺形态结构逐渐紊乱,缺血4h组细胞核以肿胀为主,少量核固缩;8h组和12h组细胞核以固缩为主,细胞陷窝加深,部分细胞溶解消失。②缺血可造成幼兔股骨头骨骺少量细胞凋亡,再灌注后凋亡细胞明显增多。3组再灌注后4,24,72,168h和再灌注后即刻比较,其细胞凋亡率差异均有显著性意义(0.3584±0.18,0.5832±0.07,0.7367±0.14,0.6172±0.06,0.1759±0.04;0.6948±0.05,0.7930±0.08,0.8867±0.06,0.8578±0.08,0.4751±0.12;0.7158±0.11,0.8082±0.06,0.9360±0.05,0.9367±0.04,0.5615±0.04,P<0.05),同一缺血时间下随再灌注时间的延长,其细胞凋亡率上升,再灌注后72h细胞凋亡率最高,168h与72h比较,差异无显著性意义(P>0.05)。结论:缺血再灌注可加重幼兔股骨头骨骺的损伤,细胞凋亡可能是缺血再灌注早期股骨头骨骺细胞损伤的重要机制。