Document Detail

In situ pinning with arthroscopic osteoplasty for mild SCFE: A preliminary technical report.
MedLine Citation:
PMID:  20532715     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty. DESCRIPTION OF TECHNIQUES: Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access was obtained and head-neck osteoplasty was completed.
METHODS: Between March 2008 and August 2009, three male patients (age range, 11-15 years; BMI, 22-31 kg/m(2)) presented with slip angles between 15º and 30º. All were ambulatory without assistance but had 2 to 12 weeks of hip and/or knee pain, limited motion and a positive impingement test. Postoperatively, patients were assessed at 6 weeks; 3 and 6 months; then every 6 months for the first two years. Hip motion, epiphyseal-metaphyseal offsets and alpha angles were determined. Patients completed the UCLA activity scale at latest followup that ranged from 6 to 23 months.
RESULTS: Arthroscopic evaluation revealed labral fraying, acetabular chondromalacia, and a prominent metaphyseal ridge. At last followup, each was pain-free and had returned to unrestricted activities. Hip motion improved in all and none demonstrated clinical impingement. Radiographs showed normalized epiphyseal-metaphyseal offsets and alpha angles.
CONCLUSIONS: In situ pinning with arthroscopic osteoplasty can limit impingement after mild slipped capital femoral epiphysis. Due to limited followup, we are unable to say whether this protocol reduces subsequent articular damage. Although we recommend performing these procedures concomitantly, they can be performed in a staged fashion, especially since hip arthroscopy following an epiphyseal slip can be challenging.
Michael Leunig; Kevin Horowitz; Hannes Manner; Reinhold Ganz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  468     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2010-12-06     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3160-7     Citation Subset:  AIM; IM    
Department of Orthopedics, Schulthess Clinic, Zürich, Switzerland.
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MeSH Terms
Arthroscopy / instrumentation*
Epiphyses, Slipped / complications,  surgery*
Femur / radiography,  surgery*
Hip Joint / physiopathology,  radiography,  surgery*
Orthopedic Fixation Devices*
Pain / etiology,  surgery
Pain Measurement
Range of Motion, Articular
Recovery of Function
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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