Abstract
Introduction and Objectives: Though not a common disease, proximal femoral epiphysiolysis (PFE) is one cause of premature degeneration of the joint. The aetio-pathogenesis is unknown. The challenge with this disorder is making an early diagnosis. This study presents the experience of our center in surgical treatment of this condition.
Materials and Methods: This is a retrospective study of 27 cases of PFE in 25 patients treated between 1990 and 1998, analyzing therapeutic management at the time of presentation and clinical, radiographic, and subjective findings in the short and medium terms. Based on duration of symptoms, the disorder is classified as acute, chronic, or subacute. Degree of displacement is classified as mild (less than 30%), moderate (30–60%), and severe (great than 60%). Dunn and Angel’s criteria were used for clinical evaluation, as modified for this study. Radiographic follow-up was based on the capitodiaphyseal Southwick angle, measuring the amount of correction postoperatively and in the medium-term examination.
Results: There were 17 males (63%) and 10 females (37%). Average age was 12.5 years. The right side was affected in 10 cases (40%), the left in 13 (52%), and both sides in 2 (8%). The majority of patients presented with chronic epiphysiolysis (44%) with mild displacement (74%). In most cases, surgical intervention consisted of in situ fixation with or without a previous attempt at reduction, based on the degree of displacement on an orthopaedic table with scope guidance. Fixations were performed primarily with Kirschner wire or cannulated screws. Preoperative complications included incomplete reduction of the fracture, breakage of the Kirschner wire, and superficial infection of the surgical wound.
Discussion and Conclusions: The worst results were seen in patients with epiphysiolysis with severe initial displacement and in patients who developed aseptic necrosis of the femoral head or chondrolysis. Intra-articular penetration with this material and valgus positioning should be avoided. At present, we are doing the fixation of the epiphysis using a single cannulated screw. We believe early detection of the process is very important in cases featuring gradual displacement.
The abstracts were prepared by Dr. E. Carlos Rodríguez-Merchán, Editor-in-Chief of the Spanish Journal of Orthopaedics and Traumatology (Revista de Ortopedia y Traumatología). Correspondence should be sent to him at Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Calle Fernández de los Ríos, 108, 28015-Madrid, Spain
