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03/11/12

Management of Minor and Moderate SCFE


S Ahmed

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

Pinning Hip Spica Epiphysiodesis

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.

Entry point anterior.

SCFE
Treatment
Pinning

Avoid joint penetration and the superior lateral quadrant

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:

Trochanteric osteotomy, Vascularised bone graft, Hip fusion.

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

THANK YOU

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