Review of the management outcome of slipped capital femoral epiphysis and the role of prophylactic contra-lateral pinning re-examined.
BACKGROUND
Slipped capital femoral epiphysis is the most common hip problem in the adolescent age group. It can involve both hips, presenting itself bilaterally at first presentation or sequentially. The overall incidence of bilateral disease is variable, but the risk of occurrence is higher when there is underlying endocrinopathy, renal disease and obesity.


METHODS
Amongst the 36 cases (44 hips) of slipped capital femoral epiphysis that we had, there were 8 cases of bilateral disease, of which 3 were bilateral sequential slips. A retrospective review of all case records and X-rays was done.


RESULTS
According to Aadalen's criteria, the results were excellent or good in 37 hips, fair in 3 hips, and poor in 2 hips. Two patients were considered as treatment failure because of avascular necrosis. The incidence of bilateral slipped capital femoral epiphysis was 22.2%. The overall average age was 11.4 years. All cases of sequential involvement presented within 15 months of the initial slip. One patient had hypothyroidism (who also had a positive family history for slipped capital femoral epiphysis), while 91.6% were above the 75th percentile for weight. There was no statistically significant difference in age, sex, race, body mass index (BMI) and weight percentile distribution between patients with unilateral and bilateral disease.


CONCLUSIONS
Satisfactory outcomes can be expected in most patients treated for slipped capital femoral epiphysis. The risk of avascular necrosis is higher in unstable slips. The role of prophylactic contra-lateral pinning should be restricted to patients with hypothalamic-pituitary-ovarian axis disease, especially hypothyroidism.
Lim
Yi Jia
YJ
Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei Street 3, Singapore. lim.yi.jia@singhealth.com.sg
Lam
Khee Sien
KS
Lee
Eng Hin
EH
D000293:Adolescent; D001858:Bone Nails; D002648:Child; D004839:Epiphyses, Slipped / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005270:Femur Head / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology; D006801:Humans; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome