Slipped capital femoral epiphysis: rationale for the technique of percutaneous in situ fixation

In pinning a slipped capital femoral epiphysis (SCFE), the position of the pin within the center of the femoral head is important for two reasons. The pin may disrupt the lateral epiphyseal artery and cause avascular necrosis (AVN), or pin penetration in certain locations may go unrecognized on radiographs. To place the pin accurately, the surgeon must be aware of where the femoral head lies in relation to the femoral neck and the shaft. Radiographs of models and of patients in various positions support the view that the femoral head in most cases of chronic SCFE rotates around the axis of the femoral neck and does not slip inferiorly. Therefore, the starting point for an in situ fixation device is the anterior femoral neck, the exact location depending on the amount of slipping.     

Slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE) is an unusual disorder in which the epiphysis of the proximal femur slips through the growth plate in a posterior direction. Significant derangement of hip function results and can be accompanied by two complications: avascular necrosis and chondrolysis. The cause remains elusive although many theories have been advanced. This article provides an overview of the disease process, diagnostic guidelines, and current treatment considerations. A case study is included.     

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.