Prior to 1990 the mainstay of treatment was multiple pin fixation with or without intra or extracapsular osteotomy. Slipped capital femoral epiphysis scfe is a hip disorder that involves the epiphysis eh piff i siss. Scfe happens when the ball slips from the neck of the femur, similar to ice cream sliding off a cone on a hot summer day. It may be idiopathic jones 1971 or secondary to underlying conditions, such as slipped capital femoral epiphysis scfe, intraarticular penetration of scfe. A computer model of slipped capital femoral epiphysis. It is one of the complications that are specifically associated with slipped capital femoral epiphysis scfe. Pdf on sep 1, 2005, robert yarbrough and others published chondrolysis.
Slipped capital femoral epiphysis bmj best practice. Its exact etiology has not been conclusively determined, and there may be some connection with hardware. We conducted a singlecentre, retrospective study and evaluated patients 70 patients, 81 hips who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. Nonoperative treatment of slipped capital femoral epiphysis. It may cause the hip to be stiff with a permanent loss of motion and pain. Sep 14, 2019 idiopathic chondrolysis is a rare condition characterized by the ultimate loss of femoroacetabular articular cartilage seen in a child with no history of trauma, slipped capital femoral epiphysis, infection, prolonged immobilization, or any other previously described disorder. Chondrolysis was significantly associated with obesity 25%, p chondrolysis, or acute cartilage necrosis of the capital femoral epiphysis, can occur in treated and untreated scfe. Slipped upper femoral epiphysis sufe is notorious for its two main complications, namely avascular necrosis avn of the femoral head and chondrolysis. For reasons that are not well understood, the ball at the head of the femur thighbone slips off the neck of the bone in a backwards direction. Chondrolysis has also been associated with prolonged immobilization. It may be idiopathic jones 1971 or secondary to underlying conditions, such as slipped capital femoral epiphysis scfe. It usually occurs in children eight to 15 years of. This is the growing portion or ball on the top part of the femur thigh bone.
In scfe, the epiphysis stays in the acetabulum while the neck is displaced anteriorly and rotates externally. Slipped capital femoral epiphysis complications bmj best. Shoulder chondrolysis typically develops very quickly, sometimes over weeks or months. Slipped capital femoral epiphysis scfe is a common hip disorder in. It may be idiopathic or secondary to other hip pathology, particularly scfe or lcp disease. Progressive slip after removal of screw fixation in slipped. Chondrolysis of the hip complicating slipped capital femoral. It may also be associated with infection, specifically septic arthritis. Slipped capital femoral epiphysis never occurs once the growth plate has closed. Chondrolysis of the hip pediatric orthopaedic society of north.
If your child has scfe, he or she may need surgery to stabilize the bone. It usually occurs in younger patients and is most often associated with recent arthroscopic surgery. Chondrolysis of the hip complicating slipped capital. Nov 02, 2016 often atraumatic or associated with a minor injury, slipped capital femoral epiphysis scfe is one of the most common adolescent hip disorders and represents a unique type of instability of the proximal femoral growth plate. First described by muller in 1889 first series on osteotomy whitman in 1909 first stabilisation with pin boyd in 1949 synonyms slipped upper femoral epiphysis adolescent coxa vara epiphyseal coxa vara epiphysiolisthesis epiphyseolysis. Idiopathic chondrolysis of the hip is an uncommon pediatric disorder characterized by the ultimate loss of articular cartilage of the femoral head and acetabulum.
Chondrolysis following slipped capital femoral epiphysis. Chondrolysis of the hip complicating slipped capital femoral epiphysis. Nine patients with chondrolysis secondary to slipped capital femoral epiphysis of the hip were followed up from a minimum of 7 to a maximum of 19 years average. Scribd is the worlds largest social reading and publishing site. In slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis. However, an immunological and autoimmune theory has been proposed. Stable slipped capital femoral epiphysis is usually treated using in situ screw fixation. Pediatric orthopaedic society of north america posna 9400 west higgins road, suite 500 rosemont, il 600184976 p. Slipped capital femoral epiphysis scfe is one of the most common disorders affecting adolescent hips, and usually appears during the early adolescent growth spurt. Chondrolysis was significantly associated with obesity 25%, p in the diagnosis of slipped capital femoral epiphysis exceeding 60 days 75%, p 0. Scfe affects approximately 210 adolescents100,000 in the u.
Penetration of the joint by metal pins can occur when treating slipped capital femoral epiphysis. Premature closure of the physeal plate after treatment of a. The roentgenographic findings and early symptoms may serve to warn the radiologist and clinician of the onset of chondrolysis. Slipped capital femoral epiphysis 812 treatment modalities for scfe include application of a hip spica, open bone peg epiphyseodesis, osteotomy, fixation with multiple pins or screws, and fixation with a single screw to prevent further slippage of the epiphysis.
Management includes protected weight bearing, physical therapy to improve range of motion, and antiinflammatory medication. Request pdf chondrolysis following slipped capital femoral epiphysis medical records and radiographs of 17 known cases of slipped capital femoral epiphysis, treated with insitu pin fixation. Chondrolysis, or acute cartilage necrosis, is a controversial and perplexing complication of slipped capital femoral epiphysis scfe in adolescents. Treatment of the slipped capital femoral epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications. Because chondrolysis can occur in both treated and untreated hips, an immune. Feb 27, 2019 slipped capital femoral epiphysis or scfe is the most common adolescent hip disease.
Idiopathic chondrolysis is an uncommon disease in which there is progressive necrosis of hyaline cartilage of both the femoral head and the acetabulum. The loss of motion may be a result of an inflammatory process in the hip joint, which is still not fully understood by surgeons. It is associated with obesity and has a higher incidence among black, hispanic and polynesian racial groups. Slipped capital femoral epiphysis scfe is a hip condition that occurs in teens and preteens who are still growing. Scfe definition anterolateral displacement of the femoral neck in relation to the proximal femoral epiphysis classification acute chondrolysis is characterised by progressive destruction of articular cartilage resulting in secondary joint space narrowing and stiffness. Chondrolysis and avascular necrosis avn are serious complications after slipped capital femoral epiphysis scfe. Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10. Chondrolysis or loss of articular cartilage of the hip joint is a devastating complication of scfe. Chondrolysis is defined as rapidly progressive loss of articular cartilage from both the femoral and acetabular sides of the hip. The degree of slipping of the proximal epiphysis of the femur was severe in five patients and moderately severe in four patients. Chondrolysis after slipped capital femoral epiphysis. Chondrolysis, also known as acute cartilage necrosis, represents acute cartilage destruction of the femoral head. Pdf the most important risk factors for avascular necrosis and. A slipped capital femoral epiphysis should not be confused with a femoral neck fracture.
Early recognition and adequate surgical fixation is essential for a good functional outcome. Chondrolysis, or acute cartilage necrosis of the capital femoral epiphysis, can occur in treated and untreated scfe. In 1990 morrissy1 introduced single screw fixation and in 1992. The prognosis is better for chondrolysis than for osteonecrosis. Avascular necrosis and chondrolysis in slipped upper. Chondrolysis occurred in 14 hips 25%, of which six 11% were due to persistent pin.
Outcome of pinning in patients with slipped capital femoral. Summary nine patients with chondrolysis secondary to slipped capital femoral epiphysis of the hip w. To study the most important risk factors for avascular necrosis avn and chondrolysis in children with slipped capital femoral epiphysis scfe. Slipped capital femoral epiphysis long term effects. This causes pain, stiffness, and instability in the affected hip. Chondrolysis following slipped capital femoral epiphysis rsna. Slipped capital femoral epiphysis scfe is an condition of the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis, and is most commonly seen in adolescent obese males. Acute chondrolysis complicating slipped capital femoral. The purpose of this study is to investigate the results of. Chondrolysis is defined as acute dissolution of articular cartilage in association with rapid progressive joint stiffness and pain. Request pdf chondrolysis following slipped capital femoral epiphysis medical records and radiographs of 17 known cases of slipped capital femoral epiphysis, treated with in situ pin fixation. Slipped capital femoral epiphysis scfe is the most common hip. In this form of chondrolysis, the affected child has no history of a slipped capital femoral epiphysis, infection, prolonged immobilization, or other previously described dis order 2. Slipped capital femoral epiphysis scfe is the most common hip disorder in adolescents, occurring in 10.
Clinical article page 30 sa orthopaedic journal summer 2009 clinical article abstract single screw in situ fixation for the management of slipped upper femoral epiphysis was introduced in 1990 and has been reported to result in a decreased incidence of avascular necrosis and chondrolysis compared to previous methods using multiple pin fixation with or without osteotomy. Scfe usually occurs in early adolescents during a rapid growth spurt age10 in females, 1216 in males scfe is bilateral involves both hips in approximately 2540% of patients. The top of the immature thigh bone the femur slips partially off the ball of the joint. Predisposing factors are present in the usual surgical methods. Chondrolysis of the hip pediatric orthopaedic society of. Chondrolysis was significantly associated with obesity 25%, p in adolescents, and it has a prevalence of 10. Acute chondrolysis complicating slipped capital femoral epiphysis. The fixation should be secured until the closure of the epiphysis to prevent further slippage. It was first described in 1930 by waldenstrom in the setting of slipped capital femoral epiphysis.
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