[Complications of prophylactic pinning for unilateral upper femur epiphysis slipping: retrospective analysis of 62 operated cases].
OBJECTIVE
The appropriate treatment for unilateral slipping of the upper epiphysis of the femur is controversial. Prophylactic surgical treatment raises the risk of bilateralization. The procedure is often unnecessary as the natural history of epiphyseal slipping is often favorable when the displacement is minimal. We analyzed the complications of systematic prophylactic treatment in order to determine the optimal attitude.


METHODS
This was a retrospective series of 62 children who underwent surgery for unilateral slipping of the superior femoral epiphysis between 1996 and 2005. Prophylactic treatment of the healthy hip was instituted systematically. The complications were noted according to Paley. We searched for factors of risk of complications, studying the bone maturity indexes, the characteristic features of the healthy femur epiphysis and the surgical technique used.


RESULTS
There were seven complications, six following prophylactic treatment and one after material removal. The rate of complications reached 11.3%. Five of the complications were minor: two local infections with favorable outcome and three patients who complained of pain in the hip at mobilization, which had totally resolved at one year. One moderate complication was noted: spiral fracture of the upper femur starting from the screw head and treated with plate fixation. The outcome was favorable. There was one severe complication: osteoarthritis of the hip joint with septicemia on day 3. The outcome was unfavorable with necrosis of the femoral head, resection and use of a spacer. A total hip arthroplasty was performed at one year.


CONCLUSIONS
Complications were globally more frequent and more severe compared to series using prophylactic screwing. The major infection complication (osteoarthritis) observed in this series has not been reported elsewhere. There was probably a center effect since we recruited all of the most complex cases in our region. We were unable to identify any factor predictive of complications. There is apparently no clear choice between systematic prophylactic treatment and careful surveillance. Prophylactic treatment in selected patients might be the key to a successful preventive approach.
Service de Chirurgie Orthopédique, HIA Laveran, Marseille, France.
A
A
Bertani
F
F
Launay
V
V
Pauly
E
E
Viehweger
J-L
JL
Jouve
G
G
Bollini
D000293:Adolescent; D001858:Bone Nails / Q000009:adverse effects*; D002648:Child; D004839:Epiphyses, Slipped / Q000517:prevention & control* / Q000601:surgery*; D005260:Female; D005269:Femur; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies