Valgisation Osteosynthesis in the Treatment of Slipped Capital Femoral Epiphysis

Abstract

Purpose: To develop a technique of fixation as to overcome problems encountered in the treatment of slipped capital femoral epiphysis (SCFE), particularly, in promoting premature closure, as the aim of the treatment, and in using multiple pins to improve the stability. Material: Left hips of five healthy immature mongrel dogs were used. Right hips served as controls.
Method: Left proximal femoral epiphysis were slipped under direct vision, then reduced and fixed with a pin passing the superior part, after this portion was destroyed. They were followed up for a year by monthly graphies with special reference to neck-shaft angle and length discrepancy. The results were assessed by the student's t-test.
Results: No avascular necrosis or loss of reduction was encountered. On the control side, neck-shaft angles showed significant difference (p<0.001) by regular varus progression where as, this was prevented on the left side (p>0.05). The difference between the sides was also significant (p<0.001) without leg length discrepancy.
Discussion: Although premature epiphyseal closure is generally accepted as the goal of the treatment, and various forms of medications and techniques are utilised for this aim, problems such as leg length discrepancy and gluteus medius lurch are not avoided and valgus osteotomies are used as salvage procedures at these instances. Partial epiphyseal closure as achieved by valgisation osteosynthesis, produces the results of salvage procedures by a single pin and without leg length discrepancy.
Conclusion: Although experimental studies are seldom directly applicable to clinical work, the results of the study, nevertheless, seems to offer solutions to some problems of the treatment of SCFE.