Treatment for unstable slipped capital femoral epiphysis: Current status and future challenge in Japan
| Autor: | Shinichi Satsuma, Takashi Saisu, Takuya Otani, Atsushi Kita, Yasuhiko Kawaguchi, Toshio Kitano, Tohru Futami |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Joint Instability
Male medicine.medical_specialty Attitude of Health Personnel medicine.medical_treatment Clinical Decision-Making Slipped Capital Femoral Epiphyses Conservative Treatment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Japan Surveys and Questionnaires medicine Humans Internal fixation Orthopedic Procedures Orthopedics and Sports Medicine Child Societies Medical Reduction (orthopedic surgery) Fixation (histology) Response rate (survey) Arthrotomy 030222 orthopedics medicine.diagnostic_test business.industry medicine.disease Surgery Treatment Outcome Bone scintigraphy Child Preschool Angiography Female Slipped capital femoral epiphysis business Forecasting |
| Zdroj: | Journal of Orthopaedic Science. 21:847-851 |
| ISSN: | 0949-2658 |
| DOI: | 10.1016/j.jos.2016.07.024 |
| Popis: | Background Treatment for unstable slipped capital femoral epiphysis (SCFE) is challenging and controversial. For many years, the debate centered around closed treatments and especially the pros and cons of manual reduction and its concrete procedure. However, recent studies reported on open treatments such as open reduction through an anterior approach and modified Dunn procedure. Being in a period of such transition, we investigated the current status and future challenge of treatment for unstable SCFE. Methods A questionnaire survey of medical institutions specializing in pediatric hip disorders across Japan was conducted. Survey items were the accurate diagnosis of physeal stability, the pre- and intra-operative evaluation of epiphyseal hemodynamics, and current treatment strategy. Results Survey responses returned from 29 out of 40 participant institutions (response rate: 73%) revealed that 55% of the institutions evaluated physeal stability based on clinical findings of ambulation capability in accordance with the Loder classification. Another 38% diagnosed physeal stability comprehensively by combining the Loder classification and imaging findings. Epiphyseal hemodynamics was assessed preoperatively in 18% of the institutions, effectively using angiography, contrast-enhanced magnetic resonance imaging (MRI), and bone scintigraphy. Intraoperative assessment was performed in 13% based on the bleeding through a drilling hole on the articular surface and observation of the cancellous bone color during open surgeries. As a treatment strategy, 52% of the institutions used in-situ fixation, while another 38% used manual reduction and internal fixation. On the other hand, open reduction was used at 3 institutions (the remaining 10%): the modified Dunn procedure at 2 institutions and arthrotomy at 1 institution. Conclusion Treatment for unstable SCFE remains controversial, but closed treatments without hemodynamic monitoring is no longer the center of the controversy. Today, the topic of the discussion is shifting toward how to correlate hemodynamic findings with treatment procedures and the indications for open treatments. |
| Databáze: | OpenAIRE |
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