title: Closed bone graft epiphysiodesis for avascular necrosis of the capital femoral epiphysis.
abstract: BACKGROUND
  Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression.
  
  
  OBJECTIVE
  We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach.
  
  
  METHODS
  We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression.
  
  
  RESULTS
  Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9.1 years) from initial injury and 5.9 years (range, 3.8-8.5 years) from CBGE. The remaining three patients were diagnosed with AVN at periods ranging from 3 to 6 months after CBGE.
  
  
  CONCLUSIONS
  Early recognition and treatment of AVN with a CBGE may alter the natural history of this complication.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors: Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-5043, USA. ght@po.cwru.edu
authors: George H
authors: GH
authors: Thompson
authors: Ethan S
authors: ES
authors: Lea
authors: Kenneth
authors: K
authors: Chin
authors: Raymond W
authors: RW
authors: Liu
authors: Jochen P
authors: JP
authors: Son-Hing
authors: Allison
authors: A
authors: Gilmore
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D018450:Disease Progression; D042241:Early Diagnosis; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000175:diagnosis; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006617:Hip Dislocation / Q000150:complications* / Q000175:diagnosis; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D060048:Slipped Capital Femoral Epiphyses / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome
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