Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study.
The following finite element study was conducted to determine whether increased body weight, femoral retroversion, and varus hip loading could sufficiently raise physeal shear strains and stresses above the yield point and predispose an adolescent hip to a slip. A computer tomography scan of a 13-year-old child with slipped capital femoral epiphysis was used to generate a solid model of the proximal femur and physis. The model was parameterized using 3-dimensional software to generate three difference angles of femoral neck version-neutral, 15 degrees retroversion, and 15 degrees anteversion. Loads of 2.7 times body weight in a 46- and 86-kg child were applied to the proximal femur to model stance on one leg. In addition, the loading vector was reoriented at various degrees of varus to study the effect of varus loading on physis shear. The results demonstrated that physis stress, strain, and displacement increased with greater body weight, retroversion, and varus displacement of the loading vector. Physis shear strain in hips with a combination of varus loading and femoral neck retroversion exceeded the reported ultimate strain values for cartilaginous soft tissues. The finite element models suggest that in an overweight child, the combination of retroversion and varus hip load may be sufficient to increase physeal strains above the yield point and result in a slip.
Fishkin
Zair
Z
Department of Orthopaedic Surgery, University at Buffalo, Buffalo, NY, and Department of Orthopaedics, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44139, USA.
Armstrong
Douglas G
DG
Shah
Hardik
H
Patra
Abani
A
Mihalko
William M
WM