engleski

Stable SCFE - Follow-up of two cohorts of patients after in situ fixation with single or two screws.

Background. For two decades accepted standard of treatment for stable SCFE was in situ placement of a single cannulated screw. Recently, a couple of papers were published with reports of progression after stable SCFE pining with a single screw due to less than ideal screw position and number of threads needed for good fixation. Patients and methods. We performed retrospective analysis of medical records of forty-six patients operated between 1981 and 2001 at single institution with a single or two screws. Nineteen patients were excluded due to incomplete documentation or they were lost for follow-up. Twenty-seven patients with 34 hips were analysed. Group 1 was comprised fifteen hips stabilized with a single screw. In group 2, nineteen hips were stabilized with two screws. Operative procedure was performed in a standard manner in both groups utilizing regular orthopaedic table and the single C-arm. Age and gender distribution was almost equal in both groups. Severity of slippage was approximately the same in both groups. All patients were followed until skeletal maturity with average f/up of 12 years (6 to 17 years). On f/up radiographs in A-P and lateral projections position of screws and number of threads in femoral head were measured. Type and number of complications were noted. Results. No progression of the slip was found in both groups. In group 1, nine hips (out of 15) had position of screw in the middle third of the femoral head on A-P projection. In only six patients, five screw threads were across femoral head physis on A-P and in five patients on lateral projection. Three patients had complications, two had coxa magna, and one patient had occasional hip pain for two years postoperatively. In group 2, nine patients (out of 19) had position of screws in the middle third of the femoral head on both projections. In seven patients five screw threads were across femoral head physis on A-P and in only six patients in lateral projection. There were ten complications in group 2 patients. Two technical complications with position of the screw and K- wire brakeage. Seven patients had coxa brevis or coxa magna and one patient had radiological signs of prearthrosis. Conclusion. While hips both groups had shown no signs of slip progression, group 2 had more complications. Ideal position of the screw placement and number of screw threads in physis was technically easier to achieve with a single screw. Usually, position of screws was better on A-P projections in both groups.

stable slipped femoral capital epiphysis ; fixation in situ ; single or two screws?

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