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• W2471570461 abstract "Case ReportProgression of Capital Femoral Epiphysis After Removal of Pins Firoz A. Khan, FRCS Mohammed Arshad Ikram, FRCS Salem Al-Zahrani, and FRCS Mamoon KremliFRCS Firoz A. Khan Search for more papers by this author , Mohammed Arshad Ikram Search for more papers by this author , Salem Al-Zahrani Search for more papers by this author , and Mamoon Kremli Search for more papers by this author Published Online:1 Jan 1995https://doi.org/10.5144/0256-4947.1995.67SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionSlipped capital femoral epiphysis is a well known cause of painful limp between 10 to 17 years of age. It is a disorder of uncertain etiology in which a dehiscence occurs through the physis and the epiphysis slowly displaces inferiorly and posteriorly. The goal of treatment is to prevent additional slipping of the epiphysis while inducing closure of the physis. Fixation with multiple pins and screws has been widely accepted as treatment for acute or chronic slipped capital femoral epiphysis.4This paper reports on a patient with a mild chronic slipped capital femoral epiphysis which was fixed in situ by multiple pins. The physis grew away from the pins and they were therefore removed before closure of the physis. After three months, the patient was readmitted with a severe acute and chronic slip which was treated by closed reduction and screw fixation.Case ReportA 12-year-old Sudanese male had a six month history of painful right hip. There was no documented history of injury. The patient was of average weight and height with no endocrine abnormality. Physical examination revealed limitation of internal rotation in the left hip. Radiograph demonstrated mild chronic slip of the left capital femoral epiphysis. The slip was fixed in situ by three partially threaded pins (Figure 1). Ten months postoperatively, at routine follow-up, radiograph showed overgrowth of the epiphysis off the pins, though the epiphyseal line was visible (Figure 2). As the patient was leaving the country permanently, and considering the overgrowth of the epiphysis off the pins, they were removed at the patient’s request (Figure 3).FIGURE 1 Anteroposterior and lateral radiograph of left hip showing mild chronic slip treated by fixation with three partially threaded pins.Download FigureFIGURE 2 Anteroposterior and lateral radiograph of left hip showing overgrowth of the epiphysis.Download FigureFIGURE 3 Anteroposterior radiograph after removal of pins from left hip.Download FigureThree months later the patient was readmitted with a painful limp and external rotation deformity of the left hip. Radiograph demonstrated severe acute and chronic slip of the left capital femoral epiphysis (Figure 4). The slip was easily reduced by closed manipulation and the fixation was done by two cannulated screws (Figure 5).FIGURE 4 Anteroposterior and lateral radiograph of left hip three months after removal of pins showing severe acute and chronic slippage.Download FigureFIGURE 5 Anteroposterior and lateral radiograph of left hip after closed reduction and fixation by two cannulated screws.Download FigureDiscussionInternal fixation with multiple pins or screw has been a standard treatment for slipped capital femoral epiphysis for many years, though in the recent literature emphasis has been placed on a single cannulated screw.1,4 Pins are removed when the physis closes. Physeal fusion was determined to have taken place when at least 75% linear closure of the physis was documented on both anteroposterior and frog leg lateral radiograph.4 If the growth of the femoral neck continues, the pins could lose their grip on the epiphysis and create the possibility of further slippage.Ward et al.4 (1992) showed three patients in a series of 49 patients whose epiphysis had overgrown completely off the screw and the growth plate was still open. There was no tendency towards an increase in the severity of the slip. Koval et al.3 mentioned a similar case where the physis grew away from the screw but did not have further slippage of the epiphysis.Overgrowth of the physis in the treatment of slipped capital femoral epiphysis is a known complication if longitudinal growth of the femoral neck continues at the normal rate and in the normal direction. Hansen2 suggested using a hook pin which allows growth to continue and eliminates the risk of displacement of the epiphysis until the growth plate has fused.In our case, we removed the pins prematurely as we thought they were not serving the required purpose. By studying this case, it is suggested that the pins should not be removed before the closure of the physis or, if the epiphysis has overgrown, they should be replaced by a new set of pins or screws to prevent further slippage of the epiphysis.ARTICLE REFERENCES:1. Aronson DD, Carlson WE. Slipped capital femoral epiphysis: a prospective study of fixation with a single screw . J Bone Joint Surg. 1992; 74A:810-9. Google Scholar2. Hansen LI. Osteosynthesis with the hook pin in slipped capital femoral epiphysis . Acta Orthop Scand. 1982; 53:87-96. Google Scholar3. Koval KJ, Lehman WB, Rose D, et al. Treatment of slipped capital femoral epiphysis with a cannulated screw technique . J Bone Joint Surg. 1989; 71A:1370-7. Google Scholar4. Ward TW, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital femoral epiphysis . J Bone Joint Surg. 1992; 74A:799-809. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 15, Issue 1January-February 1995 Metrics History Accepted11 May 1994Published online1 January 1995 InformationCopyright © 1995, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download" @default.
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• W2471570461 title "Progression of Capital Femoral Epiphysis After Removal of Pins" @default.
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