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Analysis of the Development of Avascular Necrosis in Slipped Capital Femoral Epiphysis

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DOI: 10.4236/ojo.2014.48038    2,172 Downloads   2,602 Views  

ABSTRACT

Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to determine the rate of AVN in stable slips. Method: We reviewed retrospectively all the children treated for SCFE between 2004 and 2008 at Princess Margaret Hospital. Results: Of a total of 67 patients, 51 (76%) were stable slips and 16 (24%) unstable. Avascular necrosis developed in 3 patients with stable slip (5.9%) and in 6 with unstable slip (37.5%). There was no statistically significant association found between AVN and age, weight, slip severity, pin position, number of pins used, experience of the surgeon or side affected. Those with stable presentations can develop AVN2, males are more likely and the possibility of developing AVN increases as the time from presentation to operation increased. Conclusion: AVN can occur in stable slips without joint penetration. This combined with male sex and increased time to operation, increases the risk of AVN.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Sart, R. , Gunawardana, R. and Whitewood, C. (2014) Analysis of the Development of Avascular Necrosis in Slipped Capital Femoral Epiphysis. Open Journal of Orthopedics, 4, 231-236. doi: 10.4236/ojo.2014.48038.

References

[1] Aronsson, D.D., Loder, R.T., Breur, G.J. and Weinstein, S.L. (2006) Slipped Capital Femoral Epiphysis: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons, 14, 666-679.
[2] Loder, R.T., Aronsson, D.D., Dobbs, M.B. and Weinstein, S.L. (2001) Slipped Capital Femoral Epiphysis. Instructional Course lectures, 50, 555-570.
[3] Howorth, M. (1949) Slipping of the Upper Femoral Epiphysis. Journal of Bone and Joint Surgery (American Volume), 31A, 734-747.
[4] Michelson, M.R., Ponseti, I.V., Cooper, R.R. and Maynard, J.J. (1977) The Ultrastructure of the Growth Plate in Slipped Capital Femoral Epiphysis. Journal of Bone and Joint Surgery (American Volume), 59A, 1076-1081.
[5] Loder, R.T., Richards, B.S., Shapiro, P.S., Reznick, L.R. and Aronson, D.D. (1993) Acute Slipped Capital Femoral Epiphysis: The Importance of Physeal Instability. Journal of Bone and Joint Surgery (American Volume), 75, 1134-1140.
[6] Kallio, P.E., Mah, E.T., Foster, B.K., Paterson, D.C. and LeQuesne, G.W. (1995) Slipped Capital Femoral Epiphysis: Incidence and Clinical Assessment of Physeal Instability. Journal of Bone and Joint Surgery (British Volume), 77, 752-755.
[7] Kennedy, J.G., Hresko, M.T., Kasser, J.R., Shrock, K.B., Zurakowski, D., Waters, P.M. and Millis, M.B. (2001) Osteonecrosis of the Femoral Head Associated with Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics, 21, 189-193.
http://dx.doi.org/10.1097/01241398-200103000-00011
[8] Southwick, W.O. (1967) Osteotomy through the Lesser Trochanter for Slipped Capital Femoral Epiphysis. Journal of Bone and Joint Surgery (American), 49, 807-835.
[9] Aronson, D.D. and Carlson, W.E. (1992) Slipped Capital Femoral Epiphysis: A Prospective Study of Fixation with a Single Screw. Journal of Bone and Joint Surgery (American), 74, 810-819.
[10] Boyer, D.W., Mickelson, M.R. and Ponseti, I.V. (1981) Slipped Capital Femoral Epiphysis: Long-Term Follow-Up Studies on One Hundred and Twenty-One Patients. Journal of Bone and Joint Surgery (American), 63, 85-95.
[11] Mulholland, R.C. and Gunn, D.R. (1972) Sliding Screw Plate Fixation of Intertrochanteric Femoral Fractures. Journal of Trauma-Injury Infection & Critical Care, 12, 581-591.
http://dx.doi.org/10.1097/00005373-197207000-00006
[12] Aronson, D.D. and Carlson, W.E. (1992) Slipped Capital Femoral Epiphysis: A Prospective Study of Fixation with a Single Screw. Journal of Bone and Joint Surgery (American), 74, 810-819.
[13] Fallath, S. (2004) Slipped Capital Femoral Epiphysis: An Analysis of Treatment Outcome According to Physeal Stability. Canadian Journal of Surgery, 47, 284-289.
[14] Tokmakova, K.P., Stanton, R.P. and Mason, D.E. (2003) Factors Influencing the Development of Osteonecrosis in Patients Treated for Slipped Capital Femoral Epiphysis. Journal of Bone and Joint Surgery (American Volume), 85, 798-801.
[15] Zaltz, I., Baca, G. and Clohisy, J.C. (2013) Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis. Clinical Orthopaedics and Related Research.
[16] Casey, B.H., Hamilton, H.W. and Bobechko, W.P. (1972) Reduction of Acutely Slipped Upper Femoral Epiphysis. Journal of Bone & Joint Surgery (British), 54B, 607-614.
[17] Kalogrianitis, S., Tan, C.K., Kemp, G.J., Bass, A. and Bruce, C. (2007) Does Unstable Slipped Capital Femoral Epiphysis Require Urgent Stabilization. Journal of Pediatric Orthopaedics B, 16, 6-9.
http://dx.doi.org/10.1097/01.bpb.0000236224.14325.f1
[18] Gordon, J.E., Abrahams, M.S., Dobbs, M.B., Luhmann, S.J. and Schoenecker, P.L. (2002) Early Reduction, Arthrotomy, and Cannulated Screw Fixation in Unstable Slipped Capital Femoral Epiphysis Treatment. Journal of Pediatric Orthopaedics, 22, 352-358.
http://dx.doi.org/10.1097/01241398-200205000-00017
[19] Peterson, M.D., Weiner, D.S., Green, N.E. and Terry, C.L. (1997) Acute Slipped Capital Femoral Epiphysis: The Value and Safety of Urgent Manipulative Reduction. Journal of Pediatric Orthopaedics, 17, 648-654.
http://dx.doi.org/10.1097/01241398-199709000-00013
[20] Tokmakova, K.P., Stanton, R.P. and Mason, D.E. (2003) Factors Influencing the Development of Osteonecrosis in Patients Treated for Slipped Capital Femoral Epiphysis. Journal of Bone and Joint Surgery (American), 85, 798-801.
[21] Loder, R.T. (2001) Unstable Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics, 21, 694-699.
http://dx.doi.org/10.1097/01241398-200109000-00027
[22] Herrera-Soto, J.A., Duffy, M.F., Birnbaum, M.A. and Have, V. (2008) Increased Intracapsular Pressures after Unstable Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics, 28, 723-728.
http://dx.doi.org/10.1097/BPO.0b013e318186bda3
[23] Sankar, W.N., McPartland, T.G., Millis, M.B. and Kim, Y.J. (2010) The Unstable Slipped Capital Femoral Epiphysis-Risk Factors for Osteonecrosis. Journal of Pediatric Orthopaedics, 30, 544-548.
http://dx.doi.org/10.1097/BPO.0b013e3181e4f372
[24] Tudiso, C., Caterini, R., Farsetti, P. and Potenza, V. (1999) Chondrolysis of the Hip Complicating Slipped Capital Femoral Epiphysis: Long-Term Follow-Up of Nine Patients. Journal of Pediatric Orthopaedics B, 8, 107-111.
[25] Rattey, T., Piehl, F. and Wright, J.G. (2002) Acute Slipped Capital Femoral Epiphysis: Review of Outcome and Rates of Avascular Necrosis. Journal of Bone and Joint Surgery (American Volume), 78, 398-402.

  
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