Subcapital Shortening Osteotomy for Severe Slipped Capital Femoral Epiphysis: Preliminary Results of the French Multicenter Study
| Autor: | Brice Ilharreborde, Vincent Cunin, Saad Abu-Amara |
|---|---|
| Přispěvatelé: | Department of Pediatric Orthopaedic Surgery, AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Department of Pediatric Orthopaedics, Rouen University Hospital, Rouen University |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Intraoperative Complication Adolescent Avascular necrosis Slipped Capital Femoral Epiphyses BIOMECANIQUE [SPI]Engineering Sciences [physics] 03 medical and health sciences Young Adult 0302 clinical medicine medicine Femoracetabular Impingement Humans Orthopedics and Sports Medicine 030212 general & internal medicine Child Femoroacetabular impingement Shortening osteotomy Retrospective Studies 030222 orthopedics medicine.diagnostic_test business.industry Osteonecrosis [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph] Magnetic resonance imaging Retrospective cohort study General Medicine medicine.disease Magnetic Resonance Imaging 3. Good health Surgery Osteotomy Pediatrics Perinatology and Child Health Female Complication Slipped capital femoral epiphysis business |
| Zdroj: | Journal of Pediatric Orthopedics Journal of Pediatric Orthopedics, 2018, 38 (9), pp. 471-477. ⟨10.1097/BPO.0000000000000854⟩ |
| ISSN: | 1539-2570 |
| DOI: | 10.1097/BPO.0000000000000854⟩ |
| Popis: | Background There is growing evidence that symptomatic femoroacetabular impingement (FAI) can develop after severe slipped capital femoral epiphysis (SCFE) fixed in situ. Realignment procedures have therefore gained popularity, but complication rates remain controversial. Among them, the subcapital shortening osteotomy without hip dislocation has been progressively adopted in France, but results have never been assessed to date. Methods All cases performed in 23 French university hospitals between January 2010 and March 2014 were reviewed to (1) describe the surgical procedure, (2) assess the radiologic and functional outcomes, and (3) report complications and more specifically the avascular necrosis rate (AVN) according to initial stability. Stable and unstable SCFE were distinguished following Loder's definition. Radiologic outcomes were assessed by the 3 authors to determine FAI and osteonecrosis rates. Functional outcomes were evaluated at follow-up and complications were reported. Results A total of 82 cases (45 unstable and 37 stable), performed in 10 institutions, were included with a mean follow-up of 25 months. No intraoperative complication occurred but 2 patients (2.4%) underwent unplanned early revision. Slip angle was significantly reduced (87%) without loss of correction. Overall AVN rate was 9.7%, reaching 13.3% in unstable slips. However, preoperative magnetic resonance imaging showed that most of the unstable epiphyses (4/6) were already hypoperfused before surgery. Conclusions The procedure is a reliable option for the treatment of severe SCFE. AVN rates are lower than previously reported in multicenter series of modified Dunn technique, especially in unstable slips. However, the risk of AVN in severe stable SCFE (5.4%) must still be balanced with the functional outcomes of potential future FAI. Level of evidence Level IV-therapeutic study. |
| Databáze: | OpenAIRE |
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