Abstract
Background
With recent changing approaches to the management of slipped capital femoral epiphysis (SCFE), the accurate radiographic assessment of maximum extent of displacement is crucial for planning surgical treatment.
Objective
To determine what plane best represents the maximum SCFE displacement as quantified by the head-neck angle difference (HNAD), whether HNAD can quantitatively differentiate the SCFE cohort from the normal cohort, based on CT, and how Southwick slip angle (SSA) compares to HNAD.
Materials and methods
We reviewed 19 children with SCFE (23 affected hips) with preoperative CT scans and 27 age- and sex-matched children undergoing abdominal CT for non-orthopedic problems. Head-neck angle (HNA), the angle between the femoral epiphysis and the neck axis, was measured in three planes on each hip and the HNAD (affected − unaffected hip) was determined. SSA was measured on radiographs.
Results
The coronal HNAD (mean 8.7°) was less than both the axial-oblique (mean 30.7°) and sagittal (mean 37.4°) HNADs, which were also greater than the HNADs of the normal cohort. Grouping HNAD measurements by SSA severity classification did not consistently distinguish between SCFE severity levels.
Conclusion
Axial-oblique and sagittal planes best represent the maximum SCFE displacement while biplanar radiograph may underestimate the extent of the displacement, thereby potentially altering the management between in situ pinning and capital realignment.
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References
Paré A (1572) Fractures of the neck of the femur. Cinq Livres de Chirurgie
Ziebarth K, Zilkens C, Spencer S et al (2009) Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 467:704–716
Loder RT (2006) Controversies in slipped capital femoral epiphysis. Orthop Clin North Am 37:211–221, vii
Hosalkar HS, Pandya NK, Bomar JD et al (2012) Hip impingement in slipped capital femoral epiphysis: a changing perspective. J Child Orthop 6:161–172
Fishkin Z, Armstrong DG, Shah H et al (2006) Proximal femoral physis shear in slipped capital femoral epiphysis – a finite element study. J Pediatr Orthop 26:291–294
Sankar WN, Brighton BK, Kim YJ et al (2011) Acetabular morphology in slipped capital femoral epiphysis. J Pediatr Orthop 31:254–258
Loder RT, Richards BS, Shapiro PS et al (1993) Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 75:1134–1140
Aronsson DD, Loder RT, Breur GJ et al (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14:666–679
Dodds MK, McCormack D, Mulhall KJ (2009) Femoroacetabular impingement after slipped capital femoral epiphysis: does slip severity predict clinical symptoms? J Pediatr Orthop 29:535–539
Fraitzl CR, Kafer W, Nelitz M et al (2007) Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br 89:1592–1596
Tjoumakaris FP, Wallach DM, Davidson RS (2007) Subtrochanteric osteotomy effectively treats femoroacetabular impingement after slipped capital femoral epiphysis. Clin Orthop Relat Res 464:230–237
Masse A, Aprato A, Grappiolo G et al (2012) Surgical hip dislocation for anatomic reorientation of slipped capital femoral epiphysis: preliminary results. Hip Int 22:137–144
Richolt JA, Hata N, Kikinis R et al (2008) Quantitative evaluation of angular measurements on plain radiographs in patients with slipped capital femoral epiphysis: a 3-dimensional analysis of computed tomography-based computer models of 46 femora. J Pediatr Orthop 28:291–296
Fahey JJ, O’Brien ET (1965) Acute slipped capital femoral epiphysis: review of the literature and report of ten cases. J Bone Joint Surg Am 47:1105–1127
Aronsson DD, Loder RT (1996) Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop Relat Res (322):99–110
Southwick WO (1973) Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. A technical improvement. J Bone Joint Surg Am 55:1218–1224
Ziebarth K, Domayer S, Slongo T et al (2012) Clinical stability of slipped capital femoral epiphysis does not correlate with intraoperative stability. Clin Orthop Relat Res 470:2274–2279
Kordelle J, Millis M, Jolesz FA et al (2001) Three-dimensional analysis of the proximal femur in patients with slipped capital femoral epiphysis based on computed tomography. J Pediatr Orthop 21:179–182
Loder RT (2001) Effect of femur position on the angular measurement of slipped capital femoral epiphysis. J Pediatr Orthop 21:488–494
Clohisy JC, Carlisle JC, Trousdale R et al (2009) Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res 467:666–675
Cohen MS, Gelberman RH, Griffin PP et al (1986) Slipped capital femoral epiphysis: assessment of epiphyseal displacement and angulation. J Pediatr Orthop 6:259–264
Umans H, Liebling MS, Moy L et al (1998) Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation. Skeletal Radiol 27:139–144
Weiner DS, Cook AJ, Hoyt WA Jr et al (1978) Computed tomography in the measurement of femoral anteversion. Orthopedics 1:299–306
Chen L, Boonthathip M, Cardoso F et al (2009) Acetabulum protrusio and center edge angle: new MR-imaging measurement criteria – a correlative study with measurement derived from conventional radiography. Skeletal Radiol 38:123–129
Notzli HP, Wyss TF, Stoecklin CH et al (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560
Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 49:807–835
Leunig M, Horowitz K, Manner H et al (2010) In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop Relat Res 468:3160–3167
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Monazzam, S., Dwek, J.R. & Hosalkar, H.S. Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis. Pediatr Radiol 43, 1599–1605 (2013). https://doi.org/10.1007/s00247-013-2733-y
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DOI: https://doi.org/10.1007/s00247-013-2733-y