SLIPPED CAPITAL FEMORAL EPIPHYSIS – TREATMENT ANALYSIS AND COMPLICATIONS IN 92 HIP

Abstract

The purpose of this paper is the overview of 92 cases with slipped capital femoral epiphysis (S.C.F.E.), treated in inic within the last 18 years (1985–2003).The paper reports the method of treatment and early complications concerning ischaemic necrosis and chondrolysis.

During this time, 80 children with S.C.F.E. aged 10–14 years, were treated in our clinic.Of our patients, 50 were boys and 30 girls.With regard to the degree of the slippage, 59 cases 1st degree, 32 were 2nd degree and 1 was 3rd degree;as regards the type, 63 cases were chronic, 17 acute and 12 chronicacute.They were treated surgically by pinning (use of 2 or 3 Moore-Knowls, Steinmann pins and cannulated screws) while in one case osteotomy of the femoral neck was performed.In 11 cases with 2nd degree slippage, total or partial reduction took place on the surgical table,with mild traction and strong internal rotation of the limb.In addition, in 20 cases cannulation was performed.

There has been a follow-up period of 1–10 years after surgery.

Complications: In 11 hips (in most of which Steinmann pins had been used) occurred slippage of the material inside the joint and the pin was removed (within 2 weeks).During follow-up no signs of either vascular necrosis or chondrolysis were present, with the exception of one case with 2nd degree S.C.F.E. where reduction was also attempted.

In total, 2 cases of chondrolysis occurred, in one of which signs of chondrolysis were present even before surgery, and 2 cases of vascular necrosis.The results were evaluated on clinical criteria (limping, pain, reduction in length, range of movement of hip joint) and radiological criteria (articular space, appearance of the femoral head, neck-femoral angle).

Conclusion: It seems to be that any attempt of reduction, even with mild traction, is responsible for serious complications. On the contrary, pin slippage inside the joint does not seem to lead to a poor result, provided that there is early diagnosis and immediate removal of the pin. Finally, it must be stressed that the complications in the 4 cases of either chondrolysis or vascular necrosis, occurred in patients whose weight exceeded by 25–30 % what is normally expected at their age and height.