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Per Holmdahl, Torsten Backteman, Aina Danielsson, Johan Kärrholm, Jacques Riad
PURPOSE: When treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE. METHODS: Sixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4-15...
November 5, 2016: Journal of Children's Orthopaedics
William Z Morris, Joshua K Napora, Keegan T Conry, Raymond W Liu
BACKGROUND: Factors including obesity and morphologic parameters around the hip that increase physeal stress are associated with an increased risk of slipped capital femoral epiphysis (SCFE). Recent evidence suggests that superior epiphyseal extension may confer stability to the physis and help protect against SCFE. The purpose of this study is to investigate the relationship between epiphyseal extension and SCFE using an age-matched and sex-matched cohort study. METHODS: We generated 2 separate cohorts for comparison: 89 patients with unilateral SCFE and 89 healthy subjects with no evidence of hip disease or deformity...
September 22, 2016: Journal of Pediatric Orthopedics
Vidyadhar V Upasani, Oliver Birke, Kevin E Klingele, Michael B Millis
BACKGROUND: The modified Dunn procedure facilitates femoral capital realignment for slipped capital femoral epiphysis (SCFE) through a surgical hip dislocation approach. Iatrogenic postoperative hip instability after this procedure has not been studied previously; however, we were concerned when we observed several instances of this serious complication, and we wished to study it further. QUESTIONS/PURPOSES: The purpose of this study was to evaluate the frequency, timing, and clinical presentation (including complications) associated with iatrogenic instability after the modified Dunn procedure for SCFE...
September 20, 2016: Clinical Orthopaedics and related Research
Yusuke Kohno, Yasuharu Nakashima, Toshio Kitano, Taichi Irie, Atsushi Kita, Tomoyuki Nakamura, Hirosuke Endo, Yosuke Fujii, Takayuki Kuroda, Shigeru Mitani, Hiroshi Kitoh, Masaki Matsushita, Tadashi Hattori, Koji Iwata, Yukihide Iwamoto
BACKGROUND: An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an "unsafe window", during which medical interventions would increase the risk for AVN. METHODS: This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014...
September 11, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Takuya Otani, Tohru Futami, Atsushi Kita, Toshio Kitano, Takashi Saisu, Shinichi Satsuma, Yasuhiko Kawaguchi
BACKGROUND: Treatment for unstable slipped capital femoral epiphysis (SCFE) is challenging and controversial. For many years, the debate centered around closed treatments and especially the pros and cons of manual reduction and its concrete procedure. However, recent studies reported on open treatments such as open reduction through an anterior approach and modified Dunn procedure. Being in a period of such transition, we investigated the current status and future challenge of treatment for unstable SCFE...
September 6, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Brice Ilharreborde, Vincent Cunin, Saad Abu-Amara
BACKGROUND: There is growing evidence that symptomatic femoroacetabular impingement (FAI) can develop after severe slipped capital femoral epiphysis (SCFE) fixed in situ. Realignment procedures have therefore gained popularity, but complication rates remain controversial. Among them, the subcapital shortening osteotomy without hip dislocation has been progressively adopted in France, but results have never been assessed to date. METHODS: All cases performed in 23 French university hospitals between January 2010 and March 2014 were reviewed to (1) describe the surgical procedure, (2) assess the radiologic and functional outcomes, and (3) report complications and more specifically the avascular necrosis rate (AVN) according to initial stability...
September 3, 2016: Journal of Pediatric Orthopedics
A H Abdelazeem, F K Beder, M M Abdel Karim, H Abdelazeem, H Abdel-Ghani
AIMS: This study analysed the clinical and radiological outcome of anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis (SCFE) treated by subcapital osteotomy (a modified Dunn osteotomy) through the surgical approach described by Ganz. PATIENTS AND METHODS: We prospectively studied 31 patients (32 hips; 16 females and five males; mean age 14.3 years) with SCFE. On the Southwick classification, ten were of moderate severity (head-shaft angle > 30° to 60°) and 22 were severe (head-shaft angle > 60°)...
September 2016: Bone & Joint Journal
Monica Serrano-Gonzalez, Sophie Shay, Juliana Austin, Dennis R Maceri, Pisit Pitukcheewanont
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism amongst children, with only nine previously reported cases. The objective of the study was to present the first pediatric case with a germline CDC73 (formerly known as HRPT2) mutation, and to review the literature. A 14-year-old girl presented with pathologic slipped capital femoral epiphysis (SCFE). The patient was noted to have an elevated calcium level of 3.4 mmol/L (13.4 mg/dL), a parathyroid hormone (PTH) level of 1013 ng/L (1013 pg/mL), and a 3-cm palpable neck mass...
September 1, 2016: Journal of Pediatric Endocrinology & Metabolism: JPEM
Mathew D Schur, Lindsay M Andras, Alexander M Broom, Kody K Barrett, Christine A Bowman, Herman Luther, Rachel Y Goldstein, Nicholas D Fletcher, Michael B Millis, Robert Runner, David L Skaggs
OBJECTIVE: To evaluate whether the time from symptom onset to diagnosis of slipped capital femoral epiphysis (SCFE) has improved over a recent decade compared with reports of previous decades. STUDY DESIGN: Retrospective review of 481 patients admitted with a diagnosis of SCFE at three large pediatric hospitals between January 2003 and December 2012. RESULTS: The average time from symptom onset to diagnosis of SCFE was 17 weeks (range, 0-to 169)...
October 2016: Journal of Pediatrics
Yasuharu Nakashima, Takuaki Yamamoto, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Yusuke Kohno, Yukihide Iwamoto
BACKGROUND: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. METHODS: This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads...
July 22, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Jolanda J de Poorter, Tom J Beunder, Barzi Gareb, Hubert J Oostenbroek, Gert H J M Bessems, Joris C T van der Lugt, Patrick G M Maathuis, Michiel A J van der Sande
PURPOSE: Slipped capital femoral epiphysis (SCFE) is the commonest hip disorder in adolescents. In situ pinning is commonly performed, yet lately there has been an increase in procedures with open reduction and internal fixation. These procedures, however, are technically demanding with relatively high complication rates and unknown long-term outcomes. Nevertheless, reports on long-term results of in situ fixation are not equivocal. This study evaluates the possible higher risk of worse outcome after in situ pinning of SCFE...
October 2016: Journal of Children's Orthopaedics
Andrew Moriarity, Jim Kennedy, Joe Baker, Pat Kiely
The primary aim of this study was to analyze the current level of evidence available on the surgical management of Slipped Capital Femoral Epiphysis (SCFE). Secondary aims were to correlate the level of evidence with the impact factor of the journal to evaluate the level of evidence over time, and to evaluate the geographic distribution of the studies. Therapeutic studies published in English between January 1991 and August 2014 that reported on SCFE were identified via electronic search was performed using the databases PubMed, EMBASE, and the Cochrane Library...
June 27, 2016: Orthopedic Reviews
Jeffrey S Johnson, Dennis S Weiner, Robin Jacquet, Mark J Adamczyk, Melanie A Morscher, William J Landis
BACKGROUND: Microarray technology has been used to analyze gene expression in patients with and without slipped capital femoral epiphysis (SCFE). METHODS: Proximal femoral physis core biopsies from two patients with SCFE were compared with two control specimens from age-matched patients without SCFE. Extracted RNA from frozen ground samples was subjected to microarray analysis with data tests for statistical significance between SCFE and control tissues. RESULTS: Compared to controls, SCFE samples demonstrated significant up-regulation in gene expression pathways involving physiological defense and inflammatory responses and significant down-regulation in the regulation of cellular physiologic processes, cellular metabolic pathways, and skeletal development pathways including expression of aggrecan and type II collagen, genes affecting physeal structure and integrity...
August 1, 2016: Journal of Pediatric Endocrinology & Metabolism: JPEM
C C Macía-Villa, I Sanchez-Lite, J Medina-Luezas
Slipped capital femoral epiphysis (SCFE) mainly affects overweight prepubertal children. It is usually idiopathic, but endocrinological diseases are proposed as the main cause. SCFE occurs before the closing of the femoral physis, which generally occurs at 18 years in males and 16 years in females, therefore it is considered a children's disease. However, there have been several reports of adults with SCFE and some familial cases. We present a case of bilateral SCFE in a 47 years old female with possible relationship with inhaled corticosteroids, and for the first time we collect and analyze all published cases in adults...
2016: Reumatismo
Tim Schrader, Christopher R Jones, Adam M Kaufman, Mackenzie M Herzog
BACKGROUND: The purposes of this study were to validate an innovative, percutaneous method of monitoring femoral head (epiphyseal) perfusion intraoperatively in patients with slipped capital femoral epiphysis (SCFE) and to investigate an association between intraoperative perfusion and the subsequent development of osteonecrosis. METHODS: A percutaneous screw fixation technique for SCFE was utilized. A fully threaded, cannulated, stainless-steel 7.0-mm screw was inserted into the epiphysis...
June 15, 2016: Journal of Bone and Joint Surgery. American Volume
E Schumann, D Zajonz, M Wojan, F B Kübler, P Brandmaier, C Josten, C-E Heyde, U Bühligen
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a multifactorial structural loosening in the area through the epiphyseal plate between the epiphysis and metaphysis accompanied by slippage of the femoral head in the mid-dorsal-caudal direction without additional adequate trauma. In this retrospective study, all patients with chronic SCFE were assessed who had been treated by implanting a dynamic epiphyseal telescopic (DET) screw. METHODOLOGY: All patients who had been treated at our hospital with a DET screw implant between December 2006 and November 2014 following diagnosis of chronic SCFE were included in the study...
July 2016: Der Orthopäde
Sathit Niramitmahapanya, Chaicharn Deerochanawong, Veerasak Sarinnapakorn, Thongkum Sunthornthepvarakul, Sarinee Pingsuthiwong, Pornake Athipan, Yuthana Sangsuda
A 14-year-old boy was admitted to the orthopedic clinic of Rajavithi Hospital complaining of pain in the left hip. A year earlier, pain had developed in his left joint and had gradually increased in intensity in both hips. A month before he was referred, radiographs obtained at another hospital showed bilateral slipped capital femoral epiphysis (SCFE). The patient's biochemical laboratory data showed hypercalcemia, hypophosphatemia, and a high level of intact parathyroid hormone (iPTH) compatible with primary hyperparathyroidism...
February 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Joshua K Napora, Allison Gilmore, Jochen P Son-Hing, Dominic C Grimberg, George H Thompson, Raymond W Liu
BACKGROUND: Unstable slipped capital femoral epiphysis (SCFE) has an increased incidence of avascular necrosis (AVN). Early identification and surgical intervention for AVN may help preserve the femoral head. METHODS: We retrospectively reviewed 48 patients (50 hips) with unstable SCFE managed between 2000 and 2014. AVN was diagnosed based on 2 different postoperative protocols. Seventeen patients (17 hips) had a scheduled magnetic resonance imaging (MRI) between 1 and 6 months from initial surgery, and the remaining 31 patients (33 hips) were evaluated by plain radiographs alone...
June 2, 2016: Journal of Pediatric Orthopedics
Jakob Örtegren, Lina Björklund-Sand, Malin Engbom, Carl J Tiderius
BACKGROUND: Globally, the most common method for in situ fixation of slipped capital femoral epiphysis (SCFE) is a threaded screw, which causes physeal arrest. The standard treatment in Sweden is unthreaded fixation using the Hansson hook-pin, which leads to continued growth of the femoral neck. Our purpose was to study remodeling during the remaining growth after fixation with the Hansson hook-pin. METHODS: We performed a retrospective study of 54 patients with SCFE who were treated with the Hansson hook-pin between 2001 and 2009...
June 2, 2016: Journal of Pediatric Orthopedics
Balasubramanian Balakumar, Sanjeev Madan
PURPOSE: Contemporary methods for the management of neck deformity following a healed severe slipped capital femoral epiphysis (SCFE) include subcapital neck osteotomy. METHODS: 18 patients with chronic severe SCFE in the oblique plane (mean slip angle = 70°) constituted the study group. 6 patients with an open physis underwent modified Dunn capital realignment and 12 patients with a closed physis underwent surgical dislocation with a corrective neck osteotomy...
July 25, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
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