Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study

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• 作者：Cristina Alves (1)
  Marie Steele (1)
  Unni Narayanan (1)
  Andrew Howard (1)
  Benjamin Alman (1)
  James G. Wright (1)
  
• 关键词：Slipped capital femoral epiphysis ; Closed reduction ; Open reduction ; Surgical dislocation of the hip ; Percutaneous pinning ; Avascular necrosis
• 刊名：Journal of Children's Orthopaedics
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：6
• 期：4
• 页码：277-283
• 全文大小：983KB
• 参考文献：1. Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14(12):666-79
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  3. Aronsson DD, Loder RT (1996) Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop Relat Res 322:99-10 CrossRef
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  15. Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57:499-07
  16. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83(8):1119-124 CrossRef
  17. Kennedy JG, Hresko MT, Kasser JR, Shrock KB, Zurakowski D, Waters PM et al (2001) Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop 21(2):189-93
  18. Herrera-Soto JA, Duffy MF, Birnbaum MA, Vander Have KL (2008) Increased intracapsular pressures after unstable slipped capital femoral epiphysis. J Pediatr Orthop 28(7):723-28 CrossRef
  19. Chen RC, Schoenecker PL, Dobbs MB, Luhmann SJ, Szymanski DA, Gordon JE (2009) Urgent reduction, fixation, and arthrotomy for unstable slipped capital femoral epiphysis. J Pediatr Orthop 29(7):687-94 CrossRef
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• 作者单位：Cristina Alves (1)
  Marie Steele (1)
  Unni Narayanan (1)
  Andrew Howard (1)
  Benjamin Alman (1)
  James G. Wright (1)
  
  1. Division of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G-1X8, Canada
  

文摘

Purpose The treatment of unstable slipped capital femoral epiphysis (SCFE) remains controversial. Surgical dislocation and open reduction has the potential to significantly reduce the rate of avascular necrosis (AVN) by allowing direct preservation of the femoral head blood supply. The purpose of this study was to determine if open reduction of the unstable SCFE by means of surgical hip dislocation reduced the risk of AVN compared with closed reduction and percutaneous pinning. Methods We reviewed the medical records and radiographs of patients treated at our institution between the years 2000 and 2008. Sex, age, side of slip, precipitating event, pre- and post-operative anterior physeal separation (APS) and slip angle, slip severity, time between inciting event and surgical treatment, number of screws used, development of AVN, and need for subsequent surgery were evaluated. Statistical analysis was performed to compare risk factors and occurrence of AVN. Results From 2004 to 2008, we treated 12 patients with unstable SCFEs: six had closed reduction and percutaneous pinning and six underwent open reduction by means of surgical hip dislocation. There were no statistically significant differences between the two groups regarding sex, age, slip angle, APS, time to surgery, and AVN rate. At follow-up, 4 (66.7?%) patients had AVN in the group which had open reduction, while 2 (33.3?%) patients had AVN in the group which underwent closed reduction. (p?=?0.57). Conclusions Open reduction of the unstable SCFE by means of surgical dislocation of the hip does not decrease the rate of AVN when compared to closed reduction.