gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Contralateral Epiphysiodesis to prevent leg length discrepancy following Slipped capital femoral epiphysis (SCFE)

Meeting Abstract

  • presenting/speaker Alice Wittig-Draenert - Universitätsklinik für Orthopädie und Unfallchirurgie, Salzburger Landeskliniken , Salzburg , Austria
  • Gundobert Korn - Universitätsklinik für Orthopädie und Unfallchirurgie, Salzburger Landeskliniken , Salzburg , Austria
  • Thomas Freude - Universitätsklinik für Orthopädie und Unfallchirurgie, Salzburger Landeskliniken , Salzburg , Austria
  • Franz Landauer - Universitätsklinik für Orthopädie und Unfallchirurgie, Salzburger Landeskliniken , Salzburg , Austria

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocWI19-1184

doi: 10.3205/17dkou183, urn:nbn:de:0183-17dkou1834

Veröffentlicht: 23. Oktober 2017

© 2017 Wittig-Draenert et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Severe SCFE (sSCFE) needs surgical treatment like either a Dunn or an Imhäuser osteotomy or a variation of a subcapital osteotomy with reposition of the femoral head. One of the unsolved sequela following this operative treatment is leg lengths discrepancy (LLD). While the femoral epiphysis forms the sphericity of the head and contributes to the anteversion of the femoral neck, the distal femoral epiphysis contributes more to the leg length. The eight-plate technique as epiphysiodesis of the distal femoral epiphysis (ECDFE) can stop growth for a certain time and does not destroy the epiphyseal plate. This enables regulation of growth. We performed this retrospective case control study with the hypothesis that treatment by ECDFE in severe cases results in better outcomes with respect to lower LLD.

Methods: Patient records were searched for cases that have been treated surgically for SCFE at the University hospital for orthopedics and traumatology in Salzburg from 1995 to 2016. sSCFE had received intracapsular subcapital osteotomy and anatomical reposition of the epiphysis, stabilized with K-wires. Contralateral femoral head was prophylactically pinned with K-wires in all cases. Of these, test patients received additionally temporary ECDFE using eight-plate technique while control patients received no further surgical treatment. At the end of growth for both groups LLD was measured clinically and data compared for inter-group differences. Additionally for the test group we compared LLD at the time of ECDFE with LLD at the time of removal of the osteosynthesis material.

Results: 42 patients were treated for SCFE in the respective time period. Out of these, 24 severe cases received an intracapsular subcapital osteotomy. 5 cases were excluded since 1 patient had both legs affected and at time point of the study in 4 cases end of growth was not jet reached. Among these remaining 18 patients, 5 patients were additionally treated with ECDFE. In the test group, LLD was reduced from a mean of 1,5 cm (range 1.0-2.0 cm) at the time of epiphysiodesis to a mean of 0,5 cm (range 0.0-1.0 cm) at end of growth. Comparison of the test-group vs our control (mean: 1,15 cm (range 0,5-1,5 cm)) showed significantly less LLD (p= 0.034) in the test-group using Mann - Whitney - U Test (p<5%).

Conclusion: Our results show that LLD can be reduced or even avoided with a temporary epiphysiodesis of the contralateral distal femur epiphysis. Within the limitation of our low case numbers further studies are necessary to support our findings.