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      • Record: found
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      Management of Cannulated Screw Failure and Recurrent SCFE Displacement – Case Report

      case-report

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          Abstract

          Introduction:

          SCFE occurs in 10 per 100,000 in some regions of the United States with the incidence continuing to increase. Percutaneous screw fixation is a well-accepted treatment for this disorder for over 20 years but management of complications is not well elucidated in the literature.

          Case Report:

          We describe a case where a traumatic unstable SCFE that was initially treated with closed reduction and fixation with a single transphyseal screw went on to hardware failure with recurrence of the deformity. The complication was successfully treated with closed reduction and re-cannulating the fractured screw within the epiphysis and extracting it using a conical extraction screw commonly referred to as an “easy out.” Three trans physeal screws were then placed for improved fixation strength. Follow-up at 9 months demonstrates a fused physis and no signs of avascular necrosis of the femoral head.

          Conclusion:

          Percutaneous management of SCFE screw breakage is possible utilizing specialized instruments and a precise and gentle manipulation preventing the need for more invasive treatments with their obligatory potential complications profile.

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          Most cited references20

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          Slipped capital femoral epiphysis: current concepts.

          G Breur, Randall Loder, D Aronsson … (2006)
          Slipped capital femoral epiphysis is a common hip disorder in adolescents, with an incidence of 0.2 (Japan) to 10 (United States) per 100,000. The etiology is unknown, but biomechanical and biochemical factors play an important role. Symptoms at presentation include pain in the groin, thigh, or knee. Ambulatory patients also may present with a limp. Nonambulatory patients present with excruciating pain. The slipped capital femoral epiphysis is classified as stable when the patient can walk and unstable when the patient cannot walk, even with the aid of crutches. Because the epiphysis slips posteriorly, it is best seen on lateral radiographs. The treatment of choice for stable slipped capital femoral epiphysis is single-screw fixation in situ. This method has a high probability of long-term success, with minimal risk of complications. In the patient with unstable slipped capital femoral epiphysis, urgent hip joint aspiration followed by closed reduction and single- or double-screw fixation provides the best environment for a satisfactory result, while minimizing the risk of complications.
          Article 0 comments Cited 45 times – based on 0 reviews     Review now
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            Musculoskeletal effects of obesity.

            Gilbert Chan, Taiping Chen (2009)
            The problem of obesity has become a global concern, with increased prevalence reported in the literature. Numerous comorbid conditions are known to be associated with obesity; its relationship with the development and function of the musculoskeletal system in the growing child is poorly understood. This article reviews the current literature on the various musculoskeletal effects associated with obesity in children and adolescents. The association between obesity and various musculoskeletal disorders such as slipped capital femoral epiphysis and Blount disease is well reported. Its effects on the structure and function of the musculoskeletal system have not been well documented. Recent studies suggest an increased association between obesity and musculoskeletal pain and increased fracture risk. The limitations imposed by increasing body mass appear to be directly reflected in the child's level of activity and overall functional capacity. Obesity continues to pose a serious health concern. Its impact on the development of the child's musculoskeletal system is still poorly understood. Recent data suggests that obesity affects the child's locomotor system both functionally and structurally. As the obesity epidemic grows, newer studies will be needed to help us fully understand the true impact of obesity on the musculoskeletal system of the growing child.
            Article 0 comments Cited 43 times – based on 0 reviews     Review now
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              The demographics of slipped capital femoral epiphysis. An international multicenter study.

              R. Loder (1995)
              One thousand six hundred thirty children with 1993 slipped capital femoral epiphyses were reviewed; 41.2% were girls and 58.8% were boys. There were 47.5% white, 24.8% black, 16.9% Amerindian, 7.4% Indonesian-Malay, 2.1% Native Australian/Pacific Islands, and 1.3% Indo-Mediterranean children. The diseased hip was unilateral in 77.7% and bilateral in 22.3% of the children, and chronic in 85.5% and acute in 14.5% of the children. Of the unilateral slips, 40.3% involved the right hip and 59.7% the left hip. The child's weight was greater than or equal to the ninetieth percentile in 63.2% of the children. The average age for the girls and boys was 12 and 13.5 years. The age at diagnosis decreased with increasing obesity. The youngest children were the Native Australian/Pacific Island children (11.8 years) and the oldest were the white and Indo-Mediterranean children (13 years). The Indonesian-Malay and Indo-Mediterranean children were the lightest in weight, and the black children the heaviest. The Indo-Mediterranean children had the highest proportion of boys (90.5%), and the Native Australian/Pacific Island children the lowest (50%). The highest percentage of bilaterality was in the Native Australian/Pacific Island children (38.2%), and the lowest in the Amerindian children (16.5%). The relative racial frequency of slipped capital femoral epiphysis compared with the white population was 4.5 for the Polynesian, 2.2 for the black, 1.05 for the Amerindian, 0.5 for the Indonesian-Malay, and 0.1 for the Indo-Mediterranean children. In children with unilateral involvement, the age at presentation was younger for those children in whom bilateral disease later developed (12 versus 12.9 years old). In 82% of the children with sequential bilateral slips, the second slip was diagnosed within 18 months of the first slip.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Orthop Case Reports
                Journal ID (iso-abbrev): J Orthop Case Reports
                Title: Journal of Orthopaedic Case Reports
                Publisher: Indian Orthopaedic Research Group (India )
                ISSN (Electronic): 2321-3817
                Publication date (Print): Jan-Mar 2014
                Volume: 4
                Issue: 1
                Pages: 28-31
                Affiliations
                [1 ]Department of Orthopaedics Wayne State University Orthopaedics
                Author notes
                Address of Correspondence Dr Nathan A. Jacobson M.D., Wayne State University Orthopaedics, 10000 Telegraph Road, Taylor, MI 48124. Email: njacobso@ 123456med.waye.edu Phone: 661-428-8567 / Fax: 313-3757226.
                Article
                Publisher ID: JOCR-4-28
                DOI: 10.13107/jocr.2250-0685.144
                PMC ID: 4722563
                SO-VID: dc054116-3cde-4312-bfa4-5eb73e6349e7
                Copyright © Copyright: © Indian Orthopaedic Research Group
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc-sa/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                Keywords: hardware failure,slip recurrence,scfe,complication,conical extraction screw,easy out
                Data availability:
                Keywords: hardware failure, slip recurrence, scfe, complication, conical extraction screw, easy out

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