Page 14 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 1
a procedure, with the slip worsening after premature removal of the screw. Both patients needed a subsequent operation. This emphasizes the need to leave the screw in position at least until the end of skeletal growth. Misapprehension of this disease can lead to devastating results.
Aims of this thesis:
1 To review current literature regarding SCFE, published between 2008 and 2014. Based on this literature review, the current concepts regarding SCFE are presented.
2 To assess the incidence in the past decade (1998-2010) of traumatic and non traumatic SCFE in the Netherlands based on data from the national hospitalization system of the Netherlands and to focus on the sex ratio of SCFE.
3. To assess the literature regarding the hormonal balance changes in puberty related to SCFE and their effects on the physes. We focused on the role of hormones in possibly changing the physes in SCFE and potentially weakening the physes rendering them more vulnerable to forces acting upon them.
4. To examine the histology and histopathology of the physes with SCFE and compare this to healthy physes focusing on possible differences in hormonal receptors expression, an apoptosis marker and differences in vascularity.
5. To investigate how pediatric orthopaedic surgeons, members of the WKO Netherlands and BSCOS United Kingdom prefer to diagnose and to treat acute, unstable SCFE in order to quantify differences and similarities between them and compare them with the POSNA members in the USA.
6. Toreportthefollow-upofSCFEpatientswhohadanone-stageprocedure with screw fixation and a downgrading of the slip by an Imhauser femur osteotomy. The aim was to prevent early impingement by changing the angle of the head relative to the acetabulum. The outcome parameters were clinical and radiological examination and the Harris Hip Score (HHS).
7. To report on two SCFE cases mistakenly diagnosed as Salter Harris fractures. In these cases, removal of the fixating screw resulted in a devastating deformity of the femoral head and a subsequent procedure.
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