Treatment of Slipped Capital Femoral Epiphysis (SCFE)

treatment of slipped capital femoral epiphysis.
Slipped capital femoral epiphysis (SCFE) is a disorder of adolescents
in which the growth plate is damaged and the femoral head slips down and backward off the neck of the bone at the growth plate,
the weaker area of bone.
The treatment of SCFE is operative stabilization, once SCFE is diagnosed.
Children with SCFE should be made non-weightbearing and should receive prompt consultation with an orthopedic surgeon.
Patients with acute (unstable) slips should be admitted to the hospital for treatment at initial presentation.
Hospital admission and bed rest may also be necessary for patients with bilateral SCFE,
whether acute or chronic.
The operative goals are stabilization of the diseased physis to prevent further slippage and avoidance of complications.
In extreme cases, it is important to perform surgery on the day of diagnosis.
However, most slips are stable and can wait 3-14 days for operative treatment.
The gold standard for stabilization of chronic/stable slips,
regardless of severity, is the use of a single cannulated screw placed in the center of the epiphysis.
In this procedure, the surgeon passes a screw percutaneously from the side of the top of the femur,
through the neck of the femur, through the growth plate and into the ‘ball’ section of the femur.
The screw keeps the ‘ball’ section of the femur from slipping out of place.
Some surgeons prefer using Kirschner wires,
as they claim that screws can increase the risk of premature physis closure
and can interfere with proximal femur remodeling.
results in growth disorder.
Stabilization usually involves pinning in situ without attempt at reduction
because manipulation has been found to correlate with a poorer long-term prognosis.
In situ fixation (pins or screws through the physis) has a relevant role in stable slips,
unstable slips less than 30° of deformity,
and in contralateral (normal) hips, prophylactically.
prophylactic pinning of a radiographically and clinically normal hip should be reserved to a selected group of patients,
such as very young children,
presence of endocrinopathy,
obese patients,
and those whose follow-up is thought to be difficult.
Nowadays, consensus about routine prophylactic pinning is increasing,
since the complication rate associated with the procedure is considered lower than that associated with the development of contralateral disease.
Greater slips greater than 30° necessitate an anatomical realignment to restore hip anatomy and to reduce the risk of avascular necrosis.
it may be affirmed that the open reduction is safe and efficient
the doctor may first make an open incision in the hip,
then gently reduce the head of the femur back into its normal anatomic position.
then insert metal pins to hold the bone in place.
this procedure is called surgical hip dislocation,
modified dunn procedure
Any close reduction of a high slip should be avoided, as they increase the rate of interruption of the blood supply.
Postoperative recovery:
the doctor will discuss your child’s expected time to full recovery.
It’s unique to each child and depends on many factors including severity of SCFE and type of surgical procedure done.
In general, the child will need crutches or a walker for up to about 4 weeks after surgery for stable SCFE,
and for at least 6 to 8 weeks for unstable SCFE.
After this period, crutches are discontinued, and regular activities are gradually resumed.
The child will work with a physical therapist to help strengthen leg and hip muscles and improve range of motion.
Depending on the severity of the slippage, most children may return to sports about 6 months after surgery.
However, we recommend not allowing a return to contact sports until the growth plate has closed.
the child will return to the doctor for follow-up visits for 18 to 24 months after surgery.
These visits may include X-rays every 3 to 4 months to ensure that the growth plate has closed and that no complications have developed.
The growth plate does not heal within several months
and the original unstable situation persists until the growth plate is closed.
Given the risk of progression of the slip,
the fixation of the slipped epiphysis of the hip can only be removed after closure of the growth plate.
all children with unilateral involvement who do not undergo prophylactic pinning,
should be followed closely by an orthopedic surgeon to prevent delay in diagnosis of the second slip.
The patient should be scheduled for repeat examinations of the contralateral hip during the first one to two years after initial diagnosis.
Close follow-up should continue until the child has finished growing.
In addition, patients and parents should be instructed to seek medical attention immediately if they experience any symptoms of SCFE
Complications:
Avascular necrosis:
Chondrolysis:
Impingement:
premature development of osteoarthritis.

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هو غالبا بسبب اصابة وقت لعب لكن الدكتور بيقول ان الحالات دي نسبة منها ممكن يكون بسبب هرموني ولو كده الاصابة تتكرر في مفصل تاني بالجسم
ايه التحاليل الي ممكن اعملها نتأكد ونطمن

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متى يتم ازال مسمار تثبيب راس عظمة الفخذ عند طفل15سنة

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بني درتلو العملية عندو خمسطاش يوم وكتى يقدر يحط رجلو

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