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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 12, 1592-1596.
doi: 10.1302/0301-620X.89B12.19637  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis

A MEAN FOLLOW-UP OF 14.4 YEARS AFTER PINNING IN SITU

C. R. Fraitzl, MD, Orthopaedic Surgeon1; W. Käfer, MD, Attending Orthopaedic Surgeon1; M. Nelitz, MD, Attending Orthopaedic Surgeon1; and H. Reichel, MD, Professor and Head of Department1

1 Department of Orthopaedics University of Ulm, Oberer Eselsberg 45, D-89081 Ulm, Germany

Correspondence should be sent to Dr C. R. Fraitzl; e-mail: christian.fraitzl{at}uni-ulm.de

Conventional treatment of mild slipped capital femoral epiphysis consists of fixation in situ with wires or screws. Recent contributions to the literature suggest that even a mild slip may lead to early damage of the acetabular labrum and adjacent cartilage by abutment of a prominent femoral metaphysis. It has been suggested that the appropriate treatment in mild slipped capital femoral epiphysis should not only prevent further slipping of the epiphysis, but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur.

Between October 1984 and December 1995 we treated 16 patients for unilateral mild slipped capital femoral epiphysis by fixation in situ with Kirschner wires. In this study we have reviewed these patients for clinical and radiological evidence of femoroacetabular impingement. There was little clinical indication of impingement but radiological evaluation assessing the femoral head-neck ratio and measuring the Nötzli {alpha} angle on the anteroposterior and cross-table radiographs showed significant alterations in the proximal femur. None of the affected hips had a normal head-neck ratio and the mean {alpha} angle was 86° (55° to 99°) and 55° (40° to 94°) on the anteroposterior and lateral cross-table radiographs, respectively.

While our clinical data favours conventional treatment, our radiological findings are in support of restoring the anatomy of the proximal femur to avoid or delay the development of femoroacetabular impingement following mild slipped capital femoral epiphysis.




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N. V. Bardakos, J. C. Vasconcelos, and R. N. Villar
Early outcome of hip arthroscopy for femoroacetabular impingement: THE ROLE OF FEMORAL OSTEOPLASTY IN SYMPTOMATIC IMPROVEMENT
J Bone Joint Surg Br, December 1, 2008; 90-B(12): 1570 - 1575.
[Abstract] [Full Text] [PDF]

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Comment on relationship between femoroacetabular impingement and surgical treatment of mild SCFE
Vincenzo Guzzanti
J Bone Joint Surg Br Online, 29 Jul 2008 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General