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SCFE
Radiology: Minor Slip
SCFE Radiology
SCFE
03/11/12
SCFE
03/11/12
SCFE
Classification
Head-shaft angle:
Mild < 30% or < 1/3rd Neck diameter Moderate 30% -50% or < neck diameter Severe > 50% OR > neck diameter
SCFE
Natural History:
What happens if left untreated?
4 % Require THR if untreated. 25% Bilateral slips. 70% Second slip remain asymptomatic.
SCFE
Treatment Aims
Prevent further displacement. Avoid osteonecrosis and chondrolysis. Promote closure of the epiphysis.
SCFE
Treatment Options
SCFE
Treatment Pinning
Indicated for the unstable slip. Acute or acute on chronic. Reduction by traction not manipulation
SCFE
Treatment
Pinning
Number of cannulated screws ? One better. Screws placed at the centre of the capital epiphysis on AP and lateral views.
SCFE
Treatment
Pinning
Screws left until physis closure Touch weight bear until pain free
SCFE Treatment
SCFE
Treatment
PINNING IN SITU
Most widely used Anterior start point Literature supports single screw Complications: chondrolysis - 1 screw 5 % , - 2 screws 20% , - 3 screws 30 %
SCFE
TREATMENT: Prophylactic Pinning
SCFE
Treatment
Pinning in Situ using Single Pin
Regardless of the severity, provides good long term function with low risk of complications.
SCFE
Treatment
SPICA CAST:
Advantage treating the contralateral hip. Disadvantage is chondrolysis in 19% 3% to 18% slips may displace. RARELY USED TODAY
SCFE
Treatment
Epiphysidesis:
Requires spica Slip not prevented until physis closure. Complications: - displacement, - graft failure
SCFE
Treatment Complications
CHONDROLYSIS
Joint space narrowing, motion, pain. Cause ? auto- immune. Incidence reported as high as 24%
SCFE
Treatment Complications
Chondrolysis
Treatment:
NSAIDs, CPM machine, Skin traction, Contracture release.
SCFE
Treatment Complications:
OSTEONECROSIS Incidence high with:
Pin penetration into the joint Severe Chronic slips Over reduction Attempt reduction of acute on chronic slip. Superior lateral quadrant pins
SCFE
Treatment Complications
OSTEONECROSIS: Incidence
11% with superolateral pinning 47% unstable slip 23% acute slips 11% chronic slips
SCFE
Treatment Complications
OSTEONECROSIS occurs in:
16% slip treated with osteotomy 8% slip treated with a spica 6% slip not reduced 31% when slip is reduced
SCFE
Treatment Complications
OSTEONECROSIS Treatment:
SUMMARY
SCFE needs urgent treatment Best results with in-situ single pin Forced reduction - Poor results severe slips - Poor results
03/11/12
03/11/12
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