title: Slipped capital femoral epiphysis: long-term outcome and remodelling after in situ fixation.
abstract: OBJECTIVE
  In primary treatment of slipped capital femoral epiphysis (SCFE) in situ fixation reliably prevents slip progression. The aim of this study was to examine the long-term outcome of SCFE-patients treated by transfixation with Kirschner wires with a special focus on the remodelling process of the hips under this fixation method.
  
  
  METHODS
  30 patients with stable SCFE (mean initial slip angle: 29°, mean follow-up: 10 years), who were treated with bilateral transfixation by Kirschner wires, were recruited for this study. At most recent follow-up patients were clinically and radiologically (X-ray and MRI) examined. Medical records were reviewed for previous follow-up time points.
  
  
  RESULTS
  Range of motion: At most recent follow-up the mean range of motion was: extension/flexion: 0/0/121, abduction/adduction: 44/0/31, external rotation/internal rotation: 39/0/24. Nearly all dimensions of motion significantly improved during the postoperative course.Head-shaft angle: We saw a significant reduction of the mean head-shaft angle from 29° preoperatively to 11° at most recent follow-up (p<0.0001). Harris Hip Score (HHS): 24 patients had an excellent, 3 a good, 2 a fair and 1 a poor outcome defined by HHS. Remodelling: At most recent follow-up 25 patients achieved complete remodelling. The remodelling process took place especially during the first postoperative year.Angle alpha: The mean angle alpha of the affected hips at most recent follow-up was 62°.
  
  
  CONCLUSIONS
  Transfixation with Kirschner wires leads to very good clinical, functional and radiologic results with a low complication rate. Furthermore the femoral head-neck junction retains enough plasticity for an active remodelling process.
authors.affiliation: University of Erlangen-Nuremberg, Erlangen - Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Reinhardt
authors.affiliation: Department of Paediatric Orthopaedics, Cnopf'sches Children's Hospital, Nuremberg - Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Stauner
authors.affiliation: Musculoskeletal Centre Neumarkt, Neumarkt - Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schuh
authors.affiliation: Centre for Radiology and Nuclear Medicine, Orthopaedic Clinic Wichernhaus, Schwarzenbruck - Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Steger
authors.affiliation: Department of Paediatric Orthopaedics, Cnopf'sches Children's Hospital, Nuremberg - Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Schraml
mesh_terms: D000293:Adolescent; D016723:Bone Remodeling; D001864:Bone Wires; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D060048:Slipped Capital Femoral Epiphyses / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome