Date Published: January 12, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): Michael Paloski, Benjamin C. Taylor, Mark Willits.
Slipped capital femoral epiphysis is a common injury suffered by adolescents
worldwide. Treatment of most slips can be accomplished by percutaneous screw fixation, as this is an accepted and proven method associated with minimal morbidity. Complications, although limited, can be problematic for both the patient and treating physician. These include avascular necrosis, chondrolysis, infection, and fracture. We report a case of an individual who sustained a subtrochanteric femure fracture three weeks after in situ pinning of his left hip treated with a reconstruction intramedullary nail. This option allowed both the subtrochanteric fracture and SCFE to be treated concomitantly with minimized morbidity.
Slipped capital femoral epiphysis (SCFE) is a common phenomenon of the proximal femur in adolescents with an unclear etiology. It is more common in boys than girls and there does seem to be some predilection to race, weight, and age . The current standard for most cases of stable SCFE is in situ pinning and single screw fixation has shown very promising outcomes [2, 3]. However with all orthopedic implants there is a risk of peri-implant fracture and implant failure. The case presented below illustrates a patient with a slipped capital femoral epiphysis who underwent in situ pinning and a subsequent peri-implant fracture treated in a novel way.
The patient was a 12-year-old, morbidly obese African-American male who presented to our outpatient clinic with a chief complaint of left hip pain for three weeks without difficulty ambulating. Anteroposterior and frog lateral radiographs were obtained at the clinic and a diagnosis of a stable, left preslip SCFE was made based on physical exam and radiographic changes of the physis. The patient was admitted to the hospital and underwent in situ screw fixation of his left hip the next morning with a single AO partially threaded, cannulated stainless steel screw. Intraoperatively, there were no complications and the lateral cortex was penetrated only once by the guide wire for placement of the screw. Redirection of the guide wire was necessary under fluoroscopic guidance, but this was accomplished without removing the guide pin from the single cortical hole. The patient was discharged to home care shortly thereafter with protected partial weight-bearing instructions. He followed up for his regularly scheduled postoperative appointment two weeks later and then was cleared to discontinue crutches and progress to full activity.
In situ pinning of stable SCFE with single screw fixation is well documented in the literature to produce good clinical outcomes [2, 3]. The surgical technique is thoroughly reported in the literature [2, 4, 5]. Although in situ pinning is a commonly performed procedure with good results, it should not be approached nonchalantly as complications after fixation of SCFE are not uncommon. Reports of avascular necrosis, chondrolysis, and fracture are noted in the literature . In Riley’s review of his SCFE patients, eighteen percent of the patients in their study had to undergo an additional operation directly related to the complication(s) . Complications related to hardware removal in SCFE are also well documented and can reach up to 34% incidence .