![]() | Only 14 pages are availabe for public view |
Abstract SUMMARY Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting the adolescent hip with an incidence rate of 10 per 100,000, occurs at the period of rapid growth commonly at the age of 13.4 years in males and 12.2 years in females. It’s more common in males than females. Obesity, femoral retroversion and endocrine disorders (mostly hypothyroidism) are important risk factors for SCFE. Classifications: Loder classification: provides prognostic information. • Stable: Able to bear weight with or without crutches Minimal risk of AVN (<10%). • Unstable: Unable to ambulate (not even with crutches) Associated with high risk of AVN (" ~ "47%). Southwick Angle Classification: Measurement of the difference between both hips in the femoral head-shaft angle on the frog lateral view. Difference between these two angles obtained on the affected and unaffected sides determines the degree of slip. • Mild(Grade l ) : <30° • Moderate (Grade ll): 30-50° • Severe (Grade lll): >50° Management of SCFE has a primary goal which is to stabilize the physis to prevent more slippage and decrease the risk of AVN. Aim of the work is to evaluate the outcomes of In Situ pinning in management of SCFE at one level: short and long term out comes with taking in regards the natural complications of the disorder. A total number of 5087 patients and 5266 hips with slipped capital femoral epiphysis were selected. The 16 studies ranging from 2001 to 2019. Among the 16 studies were 3 systematic review and 5 studies were retrospective studies. The main results of the study revealed that: A total number of 5087 patients and 5266 hips with slipped capital femoral epiphysis were selected. The 16 studies ranging from 2001 to 2019. Among the 16 studies were 3 systematic review and 5 studies were retrospective studies. Among the patients, 713 males and 493 females. The age ranged from 3.9 years to 17.7 years among the 16 studies. The follow-up duration ranged from 0.5 to 43 years. The Lowa hip score was 82.53 in one study. The HOOS was ranged from 44.8 to 500. A total of 4 studies allowed for estimating the weighted risk ratio between pre and postoperative angles. There was significant heterogeneity across studies (I2= 97%; P <0.00001). Among the 16 studies, there were 930 stable hips and 1316 were unstable hips. Among stable hips, eighteen developed avascular necrosis. Among unstable hips, 265 developed avascular necrosis. Results of the quality assessment using the MINORS tool. CONCLUSION Slipped capital femoral epiphysis (SCFE) is a common disorder of adolescent hips in which the capital femoral epiphysis displaces from the metaphysis through the physis. The term ”SCFE” is technically incorrect as the femoral epiphysis maintains its relationship within the acetabulum and the femoral neck and shaft displace - relative to the physis- superiorly, in adduction and external rotation deformity (exception for the rare valgus slip, where the displacement is posterior-superior). Patient with SCFE is presented with hip or knee pain with or without history of trauma. Examination of the affected hip shows shortening and external rotation of the affected limb and limited hip mobility especially internal hip rotation. Stable and unstable slips behave differently and require different treatments. For an unstable SCFE, open reduction and internal fixation on an urgent basis is shown to be associated with the best outcome. For a stable SCFE, pinning in situ is recommended for mild and, to a lesser extent, moderate slips. Screws that allow continued growth may be superior to standard screws. RECOMMENDATIONS Patient with SCFE is presented with hip or knee pain with or without history of trauma. Examination of the affected hip shows shortening and external rotation of the affected limb and limited hip mobility. For a stable SCFE, pinning in situ is recommended for mild and, to a lesser extent, moderate slips. Screws that allow continued growth may be superior to standard screws. surgical dislocation is recommended for severe slips provided patients and parents agree to take the higher AVN risk for better satisfaction and the surgical expertise is available. |