Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis

Yohei Tomaru; Hiroshi Kamada; Yuta Tsukagoshi; Shogo Nakagawa; Mio Onishi; Kenta Tanaka; Ryoko Takeuchi; Yuki Mataki; Shumpei Miyakawa; Masashi Yamazaki

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Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis

VernacularTitle:Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis
Author: Yohei TOMARU ¹ ; Hiroshi KAMADA ¹ ; Yuta TSUKAGOSHI ² ; Shogo NAKAGAWA ¹ ; Mio ONISHI ¹ ; Kenta TANAKA ¹ ; Ryoko TAKEUCHI ¹ ; Yuki MATAKI ¹ ; Shumpei MIYAKAWA ¹ ; Masashi YAMAZAKI ¹
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1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
2. Tsukuba Sports Medicine & Health Science Center, University of Tsukuba, Japan
Keywords: slipped capital femoral epiphysis; prophylactic pinning; posterior sloping angle
From:Journal of Rural Medicine 2019;14(2):191-195
CountryJapan
Language:English
Abstract: Background: The use of prophylactic contralateral pinning for slipped capital femoral epiphysis (SCFE) remains controversial. This study evaluated the outcome of SCFE treatment and examined the use of prophylactic pinning.Methods: The study included 44 patients (33 men, 11 women; 54 hips [right, 31; left, 23]), with mean age of 12.9 (7.3–29) years, who underwent treatment between 1986 and 2017, with follow-up for more than 6 months. Patients were divided into 3 groups: group 1 had bilateral SCFE at first presentation, group 2 developed contralateral side SCFE during follow-up, and group 3 had unilateral SCFE until final follow-up. Three patients who received prophylactic pinning were excluded. Univariate and multivariate logistic analyses were performed.Results: Overall, 93% (50/54) of hips underwent positional reduction and in situ fixation and 7.4% (4/54) underwent open reduction. Mean follow-up period was 4.8 (0.5–25) years. Groups 1, 2, and 3 had 7, 3, and 31 cases, respectively. Sex, age, and follow-up period showed no significant differences among the groups. The Rohrer index was significantly higher in group 1, the affected side posterior sloping angle (PSA) was significantly higher in group 3, and the contralateral side PSA and percentage with endocrinopathy were significantly higher in group 2. In multivariate logistic analysis, age, sex, Rohrer index, affected side PSA, and endocrinopathy were significantly correlated with bilateral SCFE.Conclusion: We recommend prophylactic contralateral side pinning in patients with risk factors of obesity, high PSA before slipping, and endocrinopathy. Careful observation until growth plate closure is required in patients without risk factors.