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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

SA orthop. j. vol.8 n.4 Centurion Jan. 2009

 

CLINICAL ARTICLE

 

Avascular necrosis and chondrolysis in slipped upper femoral epiphysis: A comparative study between multiple pin fixation with or without osteotomy and single screw fixation

 

 

MB NortjeI; S Dix PeekII; BC VrettosIII; EB HoffmanIV

IMBChB; Registrar, Department of Orthopaedics, University of Cape Town
IIFCS Orth(SA), MMed(Orth); Consultant, Red Cross Children's Hospital, Cape Town
IIIFC Orth(SA), MMed(Orth); Consultant, Vincent Pallotti Hospital, Cape Town
IVFC Orth(SA); Professor of Paediatric Orthopaedics, University of Cape Town, Red Cross Children's Hospital

Correspondence

 

 


ABSTRACT

Single screw in situ fixation for the management of slipped upper femoral epiphysis was introduced in 1990 and has been reported to result in a decreased incidence of avascular necrosis and chondrolysis compared to previous methods using multiple pin fixation with or without osteotomy.
To investigate this we retrospectively reviewed two groups of patients. Group A (44 patients, 55 hips) was treated over a 27-year period (1963-1989). Forty-four hips were treated with multiple pins and 11 hips had primary intra- or extracapsular osteotomy with multiple pin fixation. Group B (83 patients, 106 hips) was treated over a 7-year period (1999-2005) with single screw fixation without osteotomy. All patients were followed up for at least 2 years.
In group A avascular necrosis occurred in eight hips (14.5%); five occurred after osteotomy; two after forceful manipulation; and one was due to pinning in the posterosuperior quadrant of the femoral head. Chondrolysis occurred in 14 hips (25%), of which six (11%) were due to persistent pin penetration, and in eight (14%) chondrolysis was present at presentation (before treatment). In group B avascular necrosis occurred in only two hips (2%); both were severe, unstable slips. Chondrolysis occurred in ten hips (10%) of which two (2%) were due to persistent pin penetration, and eight (8%) had chondrolysis at presentation
We conclude that single screw fixation is a safer technique than multiple pin fixation or osteotomy. Without osteotomy avascular necrosis only occurs in severe, unstable slips. Chondrolysis due to pin penetration is almost eradicated. Chondrolysis at presentation, however, is still prevalent and occurs in female patients with severe, chronic slips.


 

 

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References

1. Morrissy RT. Slipped capital femoral epiphysis. Technique of percutaneous in situ fixation. J Pediatr Orthop 1990;10:347-350.         [ Links ]

2. Ward WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital epiphysis. J Bone Joint Surg (Am) 1992;74:799-809.         [ Links ]

3. Aronson DD and Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg(Am) 1992;74:810-819.         [ Links ]

4. Blanco JS, Taylor B, Johnston CE. Comparison of single versus multiple pin fixation in the treatment of slipped capital femoral epiphysis. J Pediatr Orthop 1992;12:384-389.         [ Links ]

5. Vrettos B, Hoffman EB. J Bone Joint Surg (Br) 1992;74:Supplement II:97.         [ Links ]

6. Casey B, Hamilton H, Bobechko W. Reduction of acutely slipped upper femoral epiphysis. J Bone Joint Surg(Br) 1972;54:607-614.         [ Links ]

7. Brodetti A. The blood supply of the femoral head in relation to the damaging effects of nails and screws. J Bone Joint Surg (Br) 1960;42:794-801.         [ Links ]

8. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital epiphysis: the importance of physeal stability. J Bone Joint Surg (Am) 1993;75:1134-1140.         [ Links ]

9. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol 2007; 4:389-410.         [ Links ]

10. Walters R and Simon SR. Joint destruction: A sequel of unrecognised pin penetration in patients with slipped capital femoral epiphyses. In The Hip: Proceedings of the Eighth Open Scientific Meeting of the Hip Society. St Louis, MO, CV Mosby, 1980:145-164.         [ Links ]

11. Tillema DA and Golding JSR. Chondrolysis following slipped capital femoral epiphysis in Jamaica. J Bone Joint Surg(Am) 1971;53:1528-1540.         [ Links ]

12. Ingram AJ, Clarke MS, Clark CS, Marshall WR. Chondrolysis complicating slipped capital femoral epiphysis. Clin Orthop 1982;163:99-109.         [ Links ]

13. Cruess RL. The pathology of acute necrosis of cartilage in slipping of the capital femoral epiphysis: a report of two cases with pathological sections. J Bone Joint Surg(Am) 1963;45:1013-24.         [ Links ]

14. Waldenstrom H. On necrosis of the joint cartilage by epiphyseolysis capitis femoris. Acta Chir Scand 1930: 67:936-46        [ Links ]

15. Mankin HJ, Sledge CB, Rothschild S, Eisenstein A. Chondrolysis of the hip. In The Hip: Proceedings of the third open scientific meeting of the Hip Society. St Louis, MO, CV Mosby. 1975:127-35.         [ Links ]

16. Vrettos BC, Hoffman EB. Chondrolysis in slipped upper femoral epiphysis: Long term study of the aetiology and natural history. J Bone Joint Surg (Br) 1993;75:956-61.         [ Links ]

17. Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: An end result study. J Bone Joint Surg(Am) 1965;47:1128-1145.         [ Links ]

18. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg(Am) 1967;49:807-35.         [ Links ]

19. Dunn DM and Angel AC. Replacement of the femoral head in severe adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg (Br) 1978;60:394-403.         [ Links ]

20. Gruber MA, Starkweather KD, Healy WA(III), Haralabatos S. Percutaneous screw removal in slipped upper femoral epiphysis. J Bone Joint Surg(Br) 1996;78:137-139.         [ Links ]

21. Ballard J and Cosgrove AP. Anterior physeal separation: a sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis. J Bone Joint Surg(Br) 2002;84:1176-1179        [ Links ]

22. Larson CB. Rating scale for hip disability. Clin Orthop 1963;31:85-93.         [ Links ]

23. Kallio PE, Mah ET, Foster BK, Paterson DC, LeQuesne GW. Slipped capital femoral epiphysis. Incidence and assessment of physeal instability. J Bone Joint Surg (Br) 1995;77:752-5.         [ Links ]

24. Rattey T, Piehl F, Wright JG. Acute slipped capital femoral epiphysis. Review of outcomes and rates of avascular necrosis J Bone Joint Surg(Am) 1996;78:398-402.         [ Links ]

25. Tokmakova KP, Stanton RP, Mason DE. Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis. J Bone Joint Surg(Am) 2003;85:798-801.         [ Links ]

26. Peterson M, Weiner DS, Greene NG, Terry CL. Acute slipped capital femoral epiphysis: The value and safety of urgent manipulative reduction. J Pediatr Orthop 1997;17:648-54.         [ Links ]

27. Loder RT. Controversies in slipped capital femoral epiphysis. Ortho Clin N Am 2006;37:211-21        [ Links ]

28. Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg (Am) 1981;63:85-95.         [ Links ]

29. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg(Am) 1991;73:667-74.         [ Links ]

30. Phillips SA, Grif?ths WEG, Clarke NMP. The timing of reduction and stabilisation of the acute, unstable, slipped upper femoral epiphysis. J Bone Joint Surg(Br) 2001;83:1046-9.         [ Links ]

31. Uglow MG, Clarke NMP. The management of slipped capital femoral epiphysis. J Bone Joint Surg(Br) 2004;86:631-5.         [ Links ]

32. Mooney JF, Sanders JO, Browne RH, Anderson DJ, Jofe M, Feldman D, Raney EM. Management of unstable/acute slipped capital femoral epiphysis. Results of a survey of the POSNA membership. J Pediatr Orthop 2005:25;162-166.         [ Links ]

33. Maeda S, Kita A, Funayama K, Kokubun S. Vascular supply to acute slipped capital epiphysis. J Pediatr Orthop 2001:21;664-667.         [ Links ]

34. Dietz FR. Traction reduction of acute and acute-on-chronic slipped capital femoral epiphysis. Clin Orthop 1994;302:101-10.         [ Links ]

35. Kay RM. Slipped Capital Femoral Epiphysis. In: Morrissy RT and Weinstein SL, editors. Lovell & Winter's Paediatric Orthopaedics, 6th Edition 2006. Vol 2 Chapter 26 pgs 1085-1124.         [ Links ]

36. Broughton NS, Todd RC, Dunn DM, Angel JC. Open reduction of the severely slipped upper femoral epiphysis. J Bone Joint Surg(Br) 1988;70:435-442.         [ Links ]

37. O'Brien ET, Fahey JJ. Remodelling of the femoral neck after in situ pinning in slipped capital femoral epiphysis. J Bone Joint Surg (Am) 1977;59:62-68.         [ Links ]

38. Hagglund GG, Hansson LI, Orderberg G. Epidemiology of slipped capital femoral epiphysis in southern Sweden. Clin Orthop 1984;191:82-94.         [ Links ]

39. Orderberg G, Hansson LI, Sandstrom S. Slipped capital femoral epiphysis in southern Sweden. Long term result with no treatment or symptomatic primary treatment. Clin Orthop 1984; 191 :95-104.         [ Links ]

40. Siegel DB, Kasser JR, Sponseller P, Gelberman RH. Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodelling after in situ fixation. J Bone Joint Surg(Am) 1991;73:659-666.         [ Links ]

41. Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhäuser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20:749-756.         [ Links ]

42. Moseley C. The "approach-withdraw" phenomenon in the pinning of slipped capital femoral epiphysis. Orthop Trans 1985; 9:497        [ Links ]

43. Jones BS. Adolescent chondrolysis of the hip joint. S Afr Med J 1971;45:196-202.         [ Links ]

44. Sparks LT and Dall G. Idiopathic chondrolysis of the hip joint in adolescents. S Afr Med J 1982;61:883-886        [ Links ]

 

 

Correspondence:
Prof EB Hoffman
7 Marne Ave
7700 Newlands
Cape Town
Tel: +27 21 674-2090; Fax: + 27 21 683-0691
Email: info@mch.org.co.za

 

 

This study has University of Cape Town Research Ethics Committee approval REC REF 086/2007. This article is the sole work of the authors. No benefits of any form are to be received from a commercial party related directly or indirectly to the subject of this article.

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