The contralateral slip. An avoidable complication and indication for prophylactic pinning in slipped upper femoral epiphysis.
Between July 1994 and June 2004, 60 patients with 76 slipped upper femoral epiphyses were managed within the adult trauma service of three hospitals. Treatment was by a single cannulated screw. Of these cases, 53 were unilateral, in 17 of which uncomplicated prophylactic fixation of the contralateral hip was performed. Of the other 36 cases, nine presented with a subsequent slip despite ongoing out-patient care. The subsequent slip was unpredictable in timing and unrelated to the age at the initial slip. It was more often unstable and in one case avascular necrosis developed. The overall rate of avascular necrosis, although in accordance with the literature, was 60% in acute unstable slips with a slip angle greater than 40 degrees. In our experience, prophylactic fixation was safer than continued observation of the contralateral hip.
MacLean
J G B
JG
Perth Royal Infirmary, Perth and Ninewells Hospital Medical School, Scotland. Jamie.maclean@tuht.scot.nhs.uk
Reddy
S K
SK
D000208:Acute Disease; D000293:Adolescent; D001863:Bone Screws; D002648:Child; D002908:Chronic Disease; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery*; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome