Page 13 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

in SCFE during adolescence. Using this review, we conducted a histopathological 1 study of the physes of SCFE patients and compared them to normal physes (which
became available after amputation or epiphysiodesis for leg length difference).
Since the choice of surgical treatment remains controversial, especially in acute, unstable SCFE, we investigated how Dutch and British pediatric orthopaedic surgeons would treat this disease. All surgeons, members of the Dutch pediatric orthopaedic society (WKO) and the British society of children orthopaedic surgery (BSCOS), were asked to complete a questionnaire to quantify agreement and disagreement about treatment of acute, unstable SCFE between these two European countries. The Pediatric Orthopaedic Society of North America (POSNA) recently published a questionnaire on the same topic, and we compared it to our questionnaire results.
Currently, many articles focus on femoro-acetabular impingement (FAI) as a cause of early arthrosis. The metaphysis in SCFE can create an anterolateral prominence on the transition between femoral head and – neck and behaves as a CAM-type deformity lesion. With flexion of the hip, this can cause impingement on the anterior acetabular rim. Many operative techniques for FAI have been described, some with a large risk of complications. We looked into a patient population of SCFE to assess the results of an one-stage operation: a screw fixation of the SCFE simultaneously with a downgrading of the slip by an early Imhauser osteotomy. The Imhauser technique flexes, derotates and valgisates the proximal part of the femur. The metaphysis is shifted away from the anterior acetabular rim thus minimising damage of the anterior rim. Given that the osteotomy level is intertrochanteric, there is a minor risk of complications such as avascular necrosis of the femoral head. The subcapital osteotomies however, which are alternatives for treating FAI, report a high risk of avascular necrosis of the femoral head.
Because SCFE is uncommon, most healthcare providers will rarely encounter it. Consequently, a child with SCFE might be wrongly diagnosed or interpreted as being a femoral head fracture, especially in the acute or acute on chronic cases. There might even be a history of a traumatic fall with or without antecedent complaints. If the disorder is misinterpreted as a fracture, one might consider removing the screw before the end of skeletal growth. This, however, carries a severe risk of postoperative slip progression. In the last chapter we describe two patients who underwent such
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