Emerging Concepts in Slipped Capital Femoral Epiphysis: Editorial Comment
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Clinical Orthopaedics and Related Research® A Publication of The Association of Bone and Joint Surgeons®
SYMPOSIUM: SLIPPED CAPITAL FEMORAL EPIPHYSIS: UPDATE AND EMERGING CONCEPTS
Emerging Concepts in Slipped Capital Femoral Epiphysis Editorial Comment Michael B. Millis MD, Ira Zaltz MD
Published online: 21 May 2013 Ó The Association of Bone and Joint Surgeons1 2013
Slipped capital femoral epiphysis (SCFE) is the most frequent acquired hip deformity that affects adolescents. Its prevalence is increasing in proportion to the increasing obesity rates found in many populations worldwide. The historical evolution of SCFE treatment has reflected our understanding of the natural history of the disorder and has closely paralleled cognitive and technical advances in orthopaedic surgery. The most common treatment of SCFE, in-situ pinning, is largely based upon classic followup studies performed at the University of Iowa. The treatment approach has changed little in the past 30 years [1, 2, 6]. In-situ fixation, now performed with decompressive arthrotomy or joint aspiration in cases of unstable slip, has evolved with the development of cannulated screws and improvements in intraoperative imaging. Despite a lack of data regarding complications and accurate
The authors certify that they, or any members of their immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR1 or the Association of Bone and Joint Surgeons1. M. B. Millis (&) Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA e-mail: [email protected]; [email protected] I. Zaltz Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
outcome measures following techniques of in-situ fixation, more complex procedures to realign the epiphysis have largely been eschewed in favor of in-situ pinning that has been historically associated with fewer postoperative complications [6]. Recently, strong evidence has been presented that suggests at least 10% of hips treated by insitu pinning for SCFE fail early following treatment and one-third more have complaints of stiffness and pain [4, 9]. Conservative estimates suggest that approximately onefifth of hips are considered clinical failures after approximately 10 years [4]. These figures suggest that orthopaedists have room to improve the treatment of this disorder, and that conclusions of the previous clinical studies upon which our treatment were based may be affected by the methods used to measure clinical performance and hip function. The modern concept of femoroacetabular imp
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