Browsing by Subject "Slipped capital femoral epiphysis"

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    Idiopathic Slipped Capital Femoral Epiphysis: Demographic Differences and Similarities between Stable, Unstable, and Valgus Types
    (MDPI, 2023-09-15) Loder, Randall T.; Gunderson, Zachary; Sun, Seungyup; Orthopaedic Surgery, School of Medicine
    Idiopathic slipped capital femoral epiphysis (SCFE) is a known disorder in pre/adolescent children with vague hip/knee pain. We wished to study the demographic differences between stable varus, unstable varus, and valgus idiopathic SCFEs using a retrospective review over a 10-year period of SCFE children seen at a tertiary children’s hospital. Standard demographic data was collected, and radiographs were measured to determine the Southwick angle and status of the tri-radiate cartilage. There were 190 patients; 138 had stable varus SCFEs, 45 unstable varus SCFEs, and 7 valgus SCFEs. All unstable SCFEs were varus, and all valgus SCFEs were stable. There were significant differences between the three groups by age at diagnosis, sex, race, SCFE severity, weight percentile, and duration of symptoms. The average age at diagnosis was 11.0 ± 1.2, 11.8 ± 1.8, and 12.3 ± 1.7 years for the valgus, unstable varus, and stable varus groups (p = 0.019), and similarly, SCFE severity was 25° ± 15°, 48° ± 18°, and 35° ± 19° (p = 0.0002) for the three same groups. Patients with valgus SCFEs were mostly female (86%) compared to the stable varus (39.9%) and unstable (47%) groups (p = 0.05) and mostly non-White (86%) (0.011). The duration of symptoms was 4.1 ± 4.1, 2.3 ± 5.0, and 4.5 ± 5.0 months for the valgus, unstable varus, and stable varus groups (p = 0.00005). These three types of idiopathic SCFEs demonstrated differences by age at diagnosis, sex, race, weight percentile, and duration of symptoms.
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    Slipped Capital Femoral Epiphysis Associated With Athletic Activity
    (Sage, 2023) Loder, Randall T.; Gunderson, Zachary J.; Sun, Seungyup; Liu, Raymond W.; Novais, Eduardo V.; Orthopaedic Surgery, School of Medicine
    Background: Little data exist regarding the association of slipped capital femoral epiphysis (SCFE) and sporting activities. Hypothesis: There is no association between SCFE and sporting activities. Study design: Retrospective review of all SCFE cases at our institution from 2010 through March 2021. Level of evidence: Level 3. Methods: All patients with idiopathic SCFE were reviewed looking for the presence/absence of sporting activities and symptom onset. Also collected were the age, symptom duration, and weight/height of the patient, sex, race, and stable/unstable nature of the SCFE. The severity of the SCFE was measured using the lateral epiphyseal-shaft angle. Results: There were 193 children (110 boys, 83 girls) with idiopathic SCFEs. The SCFE was stable in 147, unstable in 45, and unknown in 1. The average age was 12.1 ± 1.8 years, average SCFE angle 38° ± 20° and symptom duration 4.0 ± 5.1 months. An association with a sporting activity was present in 64 (33%). The sporting activity was basketball (18), football (11), baseball/softball (10), and others (23). Football, basketball, and soccer predominated in boys, baseball and running sports were equal between boys and girls, and cheerleading/gymnastics/dancing predominated in girls. Differences showed that those involved in sports had a slightly lower body mass index (BMI) (88th percentile vs 95th percentile, P = 0.00). There were no differences between those involved and those not those involved in sporting activities for symptom duration, SCFE severity, sex, race, or stable/unstable SCFE type. Conclusion: Sporting activities are associated with the onset of symptoms in 1 of 3 of patients with SCFE, refuting the null hypothesis. Clinical relevance: A high level of suspicion for SCFE should be given when any peripubertal athlete presents with hip or knee pain regardless of BMI/obesity status, and appropriate imaging performed.
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    Slipped capital femoral epiphysis: a spectrum of surgical care and changes over time
    (The British Editorial Society of Bone & Joint Surgery, 2017-04) Loder, R.T.; Medicine, School of Medicine
    PURPOSE: To survey the spectrum of surgical care in children with slipped capital femoral epiphysis (SCFE). This information is valuable in counselling the patient about the future treatment course. METHODS: Data for this study were obtained from the Pediatric Hospital Information System (PHIS) between 2004 and 2015. For all patients with an ICD9 diagnosis of 732.2, gender, ethnicity, hospital, medical record number, date of birth/admission/discharge, type of admission, length of stay, disposition and treatment(s) rendered were collected. RESULTS: A total of 13 168 procedures were performed in 11 058 unique SCFE patients, or 1.2 procedures per patient. Primary procedures were those performed for the initial treatment of the SCFE and secondary procedures as reconstructive and salvage. The majority (11 693, 88.8%) were primary. There was significant variation in the ratio of primary and secondary procedures by institution. There was a decline in in situ fixation as the initial SCFE treatment with an increase in open reduction and internal fixation over the 12-year span. Similarly, there was a significant increase in the number of secondary procedures over time as well as complications and implant removal. There was no change over time in the diagnosis of avascular necrosis. CONCLUSIONS: The average number of surgical procedures in patients was in the range of 1 to 6 and varied widely by hospital. Each physician should know his/her own hospital's data for the percentage of subsequent procedures so as to counsel the patient and family properly. The increasing number of complications over time may reflect the increasing number of more complex procedures.