The aim was to examine the descriptive epidemiology of Slipped Capital Femoral Epiphysis, with respect to geography and time. We extracted all children with a diagnosis of Slipped Capital Femoral Epiphysis from the Clinical Practice Research Database between 1990 and 2014 (24 years). CPRD is the world's largest database of primary care, which encompasses 8% of the UK population. CPRD was linked to Hospital Episode Statistics, and a validation algorithm applied to maximise sensitivity and specificity of the cases finding methodology. Poisson confidence intervals were calculated, and poison regression used. 596 cases of SCFE were identified. The internal validation algorithm supported a SCFE diagnosis in 88% cases. The age and sex distribution of cases mirrored that in the literature, offering external validity to the cases identified. There was no significant change in the incidence of SCFE over the 24-year study period, with the overall incidence being 4.8 cases per 100,00 0–16 year olds. There was no significant geographic variation in SCFE within the UK. There was a positive association with rising socioeconomic deprivation (p<0.01). There was no seasonal variation in presentation. This study found no evidence to support the common belief that SCFE incidence is increasing, and for the first time demonstrated an association with socioeconomic deprivation. The results are important for considering the feasibility of intervention studies, and offer insights into the disease aetiology

Purpose. This report compares midterm results of open neck osteoplasty + neck osteotomy vs arthroscopic osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE). Method. Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively. Results. The unpaired t-test showed that the post-operative corrections were significantly better in the ONO than the AO group. Slip angle (16.7° (1°–28.6°) Vs 47.1° (40.2° – 53.5°) p = .0003), head neck offset correction (5mm (2–13mm) Vs 0mm (0mm – 2mm) p = 0.0003), alpha angle (34.6° (23.2°–45.6°) Vs 61.88° (52.1° – 123°) p= 0.0003), Modified Harris Hip Score (MHHS) (90(86.2–99) Vs 75.5 (58.75 – 96.8) p= 0.003) and internal rotation p= 0.0002. Paired t-test showed significant improvement in corrections within the individual groups compared with their own preoperative values. The results of AO group were oblique plane slip angle (55° (47.7° – 63.2°) Vs 47.1° (40.2° – 53.5°) p= 0.001), alpha angle (90.7° (65° – 131°) Vs 61.88° (52.1° – 123°) p= 0.0001), head neck offset (0mm (−3 mm to 0mm) Vs 0mm (0mm – 2mm) p= 0.001) and MHHS (52.7 (28.7 – 89.1) Vs 75.5 (58.75 – 96.8) p= 0.0005). Complications in ONO group were varus malunion (1) and non-union(1) of the osteotomy. In the arthroscopic group persistent impingement in 3 patients and 5 were not able to return to sports. Conclusion. Our results showed improved hip function following arthroscopic osteoplasty in severe SCFE. Considering the risks of an open surgical dislocation we could find that arthroscopy contributed worthy improvement in hip function in low demand patients

Purpose

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in children 9–15 years old. The epidemiology for SCFE in the total population of Sweden has not yet been described.

Aim

Debate remains over the optimal treatment for severe unstable SCFE. AVN is the principle problem; current thinking suggests this can be minimized by emergent reduction and fixation within 24 hours. If emergent treatment is not possible, open osteotomy with a variable delay of 10–21 days has been advocated. We present our experience of delayed intracapsular cuneiform osteotomy (ICO)

We have reviewed the complication rate over a ten year period for removal of screws placed for slipped capital femoral epiphysis (SCFE) and have surveyed the views of orthopaedic surgeons with an adult hip practice in Scotland on leaving the metalwork in situ. Whilst screw removal is favoured by many orthopaedic surgeons, a recent review of the literature reported that the complication rate for removal of implants placed for SCFE was 34%.

Between 1998 and 2007 84 patients had insertion of screws for SCFE. Of these 54 patients had screws removed, 51 of these records were available. The median duration between insertion and removal of screws was 2 yrs 7 months. Of the 51 children, overall five (9.8%) had complications - three (5.9%) major and two (3.9%) minor. Two screws could not be removed; one patient sustained a fracture after screw removal and two developed an infection.

We assessed the attitudes of adult hip surgeons on this topic using an electronic questionnaire which was completed by 29 out of 40 recipients. 78.6% of respondents support routine removal and 21.4% favour leaving the screw permanently in place. 82.2% had needed to remove metalwork from a hip requiring arthroplasty in a patient whose metalwork was inserted during childhood; and described their experience of this including the complications encountered.

We have identified a lower complication rate following screw removal inserted for SCFE than in published series. Most adult hip surgeons support routine removal once the physis is closed but studies regarding the long-term outcome of retained orthopaedic implants are needed since even with this lower complication rate the question of routine removal remains unclear.

Aim:

Audit of the outcome of subcapital osteotomy for a series of cases of severe unstable slipped capital femoral epiphysis.

Aim

To inform a working group of UK paediatric surgeons (the UK SCFE Study Group) convened to design pertinent trials in slipped capital femoral epiphysis (SCFE), three centres (Bristol, Newcastle and Barts and The London) reviewed the demographics and management of children with SCFE presenting between 2007 and 2012.

The aim was to assess contemporary management of slipped capital femoral epiphysis (SCFE) by surveying members of the British Society of Children's Orthopaedic Surgery (BSCOS).

A questionnaire with 5 case vignettes was used. Two questions examined the timing of surgery for an acute unstable SCFE in a child presenting at 6 hours and at 48 hours after start of symptoms. Two further questions explored the preferred method of fixation in mild and severe stable SCFE. The final question examined the management of the contralateral normal hip. Responses were entered into an Excel spreadsheet and the data w analysed using a chi-squared test.

The response rate was 56% (110/196). 88.2% (97/110) responded that if a child presented with an acute unstable SCFE within 6 hours, they would treat it within 24 hours of presentation, compared with 40.9% (45/110) for one presenting 48 hours after the onset of symptoms (P<0.0001). 52.6% (58/110) of surveyed BSCOS members would offer surgery for an unstable SCFE between 1 and 7 days after onset of symptoms. Single screw fixation in situ was advocated by 96.4% (106/110) and 70.9% (78/110) while corrective osteotomy was preferred by 1.8% (2/110) and 26.4% (29/110) of respondents for the mild and the severe stable slips respectively (P<0.0001). Surgeons preferring osteotomy are more likely to perform an intracapsular technique. Prophylactic fixation of the contralateral normal hip was performed by 27.3% (30/110) of participants.

There are significant differences in opinions between BSCOS members as to the optimal management of SCFE in children. This reflects the variable recommendations and quality in the current scientific literature. Further research is therefore required to determine best practice and enable consensus to be reached.

Purpose. We share our experience in management of failed in-situ pinning in severe unstable Slipped Capital Femoral Epiphysis (SCFE) by surgical dislocation approach. Method. A retrospective review of hip database from 2006 to 2013 showed 41 children underwent surgical dislocation for SCFE. We identified seven who had severe slip with failed in-situ pinning. Results. The mean age at presentation was 11.9 years (10–14 years). The average interval between in-situ pinning and surgical dislocation was 10 months (2 to 18 months). The mean follow-up was 50.14 months (25 – 66 months). The mean preoperative slip angle in the oblique plane was 76° (61.1° – 121.5°), the mean preoperative alpha angle was 127.3° (93.1° – 145°), and preoperative head neck offset was −12.7mm (0 – −21.2mm). The mean corrections at latest follow-up were oblique plane slip angle 20.6° (4.2° – 41.8°), alpha angle 51.3° (45.3° – 58°), and head-neck offset 9.5mm (1 – 16.2mm). The mean Modified Harris Hip Score (MHHS) preoperatively was 19.57 (0 – 56) and the mean non-arthritic hip score (NAHS) was 21.07 (5 – 51.5). The mean MHHS at the last visit was 88.97 (71 – 96) and NAHS was 84.28 (69.5 – 91). All patients had gross external rotation deformity at presentation; mean internal rotation of 25° ranging from (0 – 40°) was achieved at follow-up. Four patients had avascular necrosis identified on subtraction MRI scan preoperatively. These four underwent second stage hinged distraction of the hip. Mean duration of hinged distraction was 7.6 months. At follow-up 4 had Tonnis 0, one Tonnis 1 and two Tonnis 2 grade of osteoarthritis. Conclusion. The short-term result of our protocol for management of failed in-situ pinning by staged surgical dislocation and hinged distraction has been encouraging. This could potentially prolong the life of native hip to the third decade of life before definitive salvage procedures could be contemplated

The aim of this study was to determine whether an osteoplasty of the femoral neck performed at the same time as an intertrochanteric Imhäuser osteotomy led to an improved functional outcome or increased morbidity. A total of 20 hips in 19 patients (12 left, 8 right, 13 male, 6 female), who underwent an Imhäuser intertrochanteric osteotomy following a slipped capital femoral epiphysis were assessed over an eight-year period. A total of 13 hips in 13 patients had an osteoplasty of the femoral neck at the same time. The remaining six patients (seven hips) had intertrochanteric osteotomy alone. The mean age was 15.3 years (13 to 20) with a mean follow-up of 57.8 months (15 to 117); 19 of the slips were severe (Southwick grade III) and one was moderate (grade II), with a mean slip angle of 65.3° (50° to 80°); 17 of the slips were stable and three unstable at initial presentation. The mean Non-Arthritic Hip Scores (NAHS) in patients who underwent osteoplasty was 91.7 (76.3 to 100) and the mean NAHS in patients who did not undergo osteoplasty was 76.6 (41.3 to 100) (p = 0.056). Two patients required a subsequent arthroplasty and neither of these patients had an osteoplasty. No hips developed osteonecrosis or chondrolysis, and there was no increase in complications related to the osteoplasty. We recommend that for patients with a slipped upper femoral epiphysis undergoing an intertrochanteric osteotomy, the addition of an osteoplasty of the femoral neck should be considered.

Cite this article: Bone Joint J 2014;96-B:1119–23.

We undertook a retrospective comparative study of all patients with an unstable slipped capital femoral epiphysis presenting to a single centre between 1998 and 2011. There were 45 patients (46 hips; mean age 12.6 years; 9 to 14); 16 hips underwent intracapsular cuneiform osteotomy and 30 underwent pinning in situ, with varying degrees of serendipitous reduction. No patient in the osteotomy group was lost to follow-up, which was undertaken at a mean of 28 months (11 to 48); four patients in the pinning in situ group were lost to follow-up, which occurred at a mean of 30 months (10 to 50). Avascular necrosis (AVN) occurred in four hips (25%) following osteotomy and in 11 (42%) following pinning in situ. AVN was not seen in five hips for which osteotomy was undertaken > 13 days after presentation. AVN occurred in four of ten (40%) hips undergoing emergency pinning in situ, compared with four of 15 (47%) undergoing non-emergency pinning. The rate of AVN was 67% (four of six) in those undergoing pinning on the second or third day after presentation.

Pinning in situ following complete reduction led to AVN in four out of five cases (80%). In comparison, pinning in situ following incomplete reduction led to AVN in 7 of 21 cases (33%). The rate of development of AVN was significantly higher following pinning in situ with complete reduction than following intracapsular osteotomy (p = 0.048). Complete reduction was more frequent in those treated by emergency pinning and was strongly associated with AVN (p = 0.005).

Non-emergency intracapsular osteotomy may have a protective effect on the epiphyseal vasculature and should be undertaken with a delay of at least two weeks. The place of emergency pinning in situ in these patients needs to be re-evaluated, possibly in favour of an emergency open procedure or delayed intracapsular osteotomy. Non-emergency pinning in situ should be undertaken after a delay of at least five days, with the greatest risk at two and three days after presentation. Intracapsular osteotomy should be undertaken after a delay of at least 14 days. In our experience, closed epiphyseal reduction is harmful.

Cite this article: Bone Joint J 2015;97-B:412–19.