THE MANAGEMENT OF SLIPPED UPPER FEMORAL EPIPHYSIS IN AN ADULT TRAUMA SERVICE

Abstract

Introduction: The consequences of the complications associated with the management of slipped upper femoral epiphysis are a major source of disability in young adults. Whilst the management of chondrolysis, avascular necrosis or malunion of the femoral neck is usually undertaken by paediatric orthopaedic surgeons the initial management of SUFE in many regions is as part of an adult trauma service. This retrospective audit assessed the outcome of the management of SUFE in one such health region in which treatment occurred at three sites by a number of surgeons of varying experience. The aim was to compare our outcomes with those published and to identify any local issues.

Method: Review of case notes and xrays of all patients treated over a ten year period as recorded in theatre records. Fixation in all cases was by a single cannulated screw.

Results: Of the 64 cases that presented during this period adequate records for 60 patients were retrieved. 75 slips were recorded, 15 of which were bilateral. In 17 patients prophylactic pinning was performed in the remaining 43 patients nine presented with subsequent slips. Of these, eight were unstable of which two had slip angles greater than 60°, in one of these avascular necrosis developed. Three other cases of avascular necrosis occurred (incidence 5%) all in unstable slips. Chondrolysis occurred in one patient with persistent pin penetration. In the remaining 91 cannulated screws that were inserted no complications were observed.

Discussion: The complication rates observed in this series are within those accepted in the literature. The high incidence of subsequent slips and the attendant severity of these when compared with the relative safety of contemporary cannulated screw fixation has lead us to recommend prophylactic pinning in our region.