Windshield-wiper loosening: a complication of in situ screw fixation of slipped capital femoral epiphysis.
A retrospective review of patients treated for slipped capital femoral epiphysis (SCFE) by in situ screw fixation with a cannulated titanium screw was performed. Of the 18 hips with at least 1-year follow-up, windshield-wiper loosening of the cannulated screw in the femoral head had occurred in three. In all three cases, the screw had been left protruding > 1.5 cm from the anterolateral cortex of the femur. We postulate that with hip motion the protruding screw is toggled by the anterolateral soft tissues, causing a windshield-wiper effect in the femoral head, leading to eventual screw loosening. We believe that leaving the screw protruding from the fascia lata is a potential source of screw loosening by the windshield-wiper mechanism and now routinely place the screw head within 1.5 cm of the anterolateral cortex of the femur.
Maletis
G B
GB
Childrens Hospital Los Angeles, California.
Bassett
G S
GS
D000293:Adolescent; D001863:Bone Screws; D002648:Child; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005270:Femur Head; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies