engleski

Unstable slipped capital femolral epiphysis

Slipped capital femoral epiphysis(SCFE) is children's hip development disorder, most common in preadolescent growth spurt. Disorder can lead to invalidity and secondary coxarthrosis in aduldhood. Majority of SCFE are stable and chronic, smaller number are acute and unstable. In unstable SCFE, usually manifested after smaller trauma, children are unable to walk or have serious walking difficulties. Aim of work was to determine prevalence, course and outcome of unstable SCFE treatment in population of patients with SCFE. We analized, according to surgical and hospital protocols, number and course of unstable SCFE treated on Clinic for Orthopaedics of the Clinical Hospital Center Zagreb and University of Zagreb Medical School, in period between year 2000.and 2007. 50 patients and 53 hips with SCFE underwent an operation, thereof 8 patients and 8 hips with unstable SCFE, 6 boys and 2 girls, ages ranged from 9 to 14. Two patients had 2nd degree, six had 3rd degree SCFE, classified according to Mueller. Six patients were unable to walk, two had walking difficulties with severe pain. In all 8 patients closed reduction was made, which included preoperative cutaneous traction and manipulative gradual reduction under general anesthesia, followed by fixation. In 4 cases fixation was made with 2 cannulated screws, in 2 cases with one screw and 2 Kirschner wires, in one case with one screw and one Kirschner wire and in one case with 3 Kirschner wires with threaded end. After the postoperative pain stopped and rehabilitation was carried out, all patients had fullhip mobility and suffered no pain. No case of avascular of the capital femoral epiphysis nor progression of SCFE was reported. Early migration of Kirschner wires was reported in one patient. The prevalence of unstable SCFE in our patients with SCFE is 15%. Unstable SCFE is emergency in orthopaedics and should be carefully reducted and fixed with cannulated screws or Kirschner wires with threaded end as soon as possible.

slipped capital femoral epiphysis; unstable; hip; reduction; fixation; avascular necrosis

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