title: Evolution of slipped capital femoral epiphysis after in situ screw fixation at a mean 11 years' follow-up: a 222 case series.
abstract: BACKGROUND
  Slipped capital femoral epiphysis (SCFE) can lead to hip impingement, more or less rapidly depending on initial slippage severity and on surgical technique. Various surgical options are applicable, including in situ fixation (ISF). The aim of the present study was to look for long-term signs of radiological impingement in hips treated for SCFE by IFS, in order to identify a slip threshold beyond which impingement more regularly appears.
  
  
  METHODS
  A multicenter retrospective study assessed the clinical and radiological evolution of patients operated on by ISF for SCFE, with a minimum 10 year's follow-up. Coxometric analysis of postoperative and last follow-up radiographs was performed. Functional outcome was assessed on Oxford hip score and radiographic osteoarthritis on the Tönnis classification. Alpha angle was measured on lateral views to highlight hip impingement.
  
  
  RESULTS
  Two hundred and twenty-two hips were included, with a mean 11.2 years' follow-up. Mean age at diagnosis was 12.8 years. Mean preoperative Southwick angle was 38.8°, with 43% of hips at stage I, 42% at stage II and 15% at stage III. At latest follow-up, mean Oxford score was 14.86, with 88% of hips rated Tönnis 0 or I. Only 15 cases of impingement were diagnosed. There seemed to be a non-significant trend for hip impingement in SCFE exceeding 35°.
  
  
  CONCLUSIONS
  ISF led to hip impingement in moderate to severe initial epiphyseal displacement. However, in smaller displacement, the consequences were milder, with perfectly satisfactory function scores and no clinical or radiological evidence of impingement. The threshold seemed to be around 35° slippage, beyond which other surgical options than ISF should be considered. Thus, it seems reasonable to propose isolated ISF in SCFE<35° and to treat symptomatic impingement by surgery in stage II slips.
authors.affiliation: Chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France. Electronic address: eric.nectoux@chru-lille.fr.
authors.forename: E
authors.initials: E
authors.lastname: Nectoux
authors.affiliation: Chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Décaudain
authors.affiliation: Service d'orthopédie-traumatologie pédiatrique, hôpital des enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Accadbled
authors.affiliation: Service de chirurgie infantile, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Hamel
authors.affiliation: LyonOrthoClinic, 29B, avenue des Sources, 69009 Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Bonin
authors.affiliation: Service d'orthopédie-traumatologie pédiatrique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Gicquel
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D002648:Child; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D060048:Slipped Capital Femoral Epiphyses / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Femoroacetabular impingement; In situ screw fixation; Slipped capital femoral epiphysis