Epiphyseal Angulation and Related Spatial Orientation in Slipped Capital Femoral Epiphysis: Theoretical Model and Biomechanical Explanation of Varus and Valgus Slip

Overview

Journal JB JS Open Access

Date 2020 Dec 30

PMID 33376931

Citations 1

Authors

Emanuel Gautier

Caroline Passaplan

Lucienne Gautier

Affiliations

Soon will be listed here.

Abstract

Methods: Eighteen hips in 18 patients with SCFE were included in the analysis. Trigonometric calculations, based on angle measurements using 2 conventional radiographs in planes that are perpendicular to each other, were used to determine the angulation of the epiphysis and its orientation in space.

Results: The mean absolute epiphyseal obliquity of the SCFE hips was 56.2° and the spatial orientation was 36.5°. The mean obliquity of the contralateral side was 34.0°, with a related spatial orientation of 16.8°. The maximum error can reach up to 9.9° (or 41%) when comparing the calculated angles with the angle measurements on radiographs.

Conclusions: On standard radiographs, the epiphyseal angulation in SCFE is consistently underestimated. As a consequence, the assigned classification of some patients may be 1 severity group too low, which impacts the value of traditional severity classification for surgical decision-making. The analysis of the spatial orientation of the slip with the concomitant direction of the resultant shear can partially explain varus and valgus slip in SCFE.

Level Of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Citing Articles

Is a Femoro-Acetabular Impingement Type Cam Predictable after Slipped Capital Femoral Epiphysis?.

Wirries N, Heinrich G, Derksen A, Budde S, Floerkemeier T, Windhagen H Children (Basel). 2021; 8(11).

PMID: 34828705 PMC: 8623557. DOI: 10.3390/children8110992.

References

Dunn D . THE TREATMENT OF ADOLESCENT SLIPPING OF THE UPPER FEMORAL EPIPHYSIS. J Bone Joint Surg Br. 1964; 46:621-9. View

Venkatadass K, Shetty A, Rajasekaran S . Valgus slipped capital femoral epiphysis: report of two cases and a comprehensive review of literature. J Pediatr Orthop B. 2011; 20(5):291-4. DOI: 10.1097/BPB.0b013e328346d2ec. View

Engelhardt P, Roesler H . [Radiometry of epiphyseolysis capitis femoris. A comparison of conventional roentgen study with axial computerized tomography]. Z Orthop Ihre Grenzgeb. 1987; 125(2):177-82. DOI: 10.1055/s-2008-1044910. View

Monazzam S, Dwek J, Hosalkar H . Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis. Pediatr Radiol. 2013; 43(12):1599-605. DOI: 10.1007/s00247-013-2733-y. View

Gautier E, GANZ K, Krugel N, Gill T, Ganz R . Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000; 82(5):679-83. DOI: 10.1302/0301-620x.82b5.10426. View

Amiraian D, Sarwar Z, Bireley 2nd W, Moran E . Valgus slipped capital femoral epiphysis with contralateral pre-slip. Skeletal Radiol. 2017; 46(9):1261-1265. DOI: 10.1007/s00256-017-2654-1. View

Klein A, JOPLIN R, REIDY J, HANELIN J . Management of the contralateral hip in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1953; 35-A(1):81-7. View

BILLING L, Eklof O . Slip of the capital femoral epiphysis: revival of a method of assessment. Pediatr Radiol. 1984; 14(6):413-8. DOI: 10.1007/BF02343431. View

Carney B, Weinstein S, Noble J . Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1991; 73(5):667-74. View

10.

Jones C, Cooper A, Doucette J, Buchan L, Wilson D, Mulpuri K . Southwick angle measurements and SCFE slip severity classifications are affected by frog-lateral positioning. Skeletal Radiol. 2017; 47(1):79-84. DOI: 10.1007/s00256-017-2761-z. View

11.

Hurley J, Betz R, Loder R, DAVIDSON R, Alburger P, STEEL H . Slipped capital femoral epiphysis. The prevalence of late contralateral slip. J Bone Joint Surg Am. 1996; 78(2):226-30. DOI: 10.2106/00004623-199602000-00009. View

12.

Park S, Hsu J, Rendon N, Wolfgruber H, Wells L . The utility of posterior sloping angle in predicting contralateral slipped capital femoral epiphysis. J Pediatr Orthop. 2010; 30(7):683-9. DOI: 10.1097/BPO.0b013e3181efb888. View

13.

Schultz W, Weinstein J, Weinstein S, Smith B . Prophylactic pinning of the contralateral hip in slipped capital femoral epiphysis : evaluation of long-term outcome for the contralateral hip with use of decision analysis. J Bone Joint Surg Am. 2002; 84(8):1305-14. DOI: 10.2106/00004623-200208000-00003. View

14.

FAHEY J, OBrien E . ACUTE SLIPPED CAPITAL FEMORAL EPIPHYSIS: REVIEW OF THE LITERATURE AND REPORT OF TEN CASES. J Bone Joint Surg Am. 1965; 47:1105-27. View

15.

Leunig M, Manner H, Turchetto L, Ganz R . Femoral and acetabular re-alignment in slipped capital femoral epiphysis. J Child Orthop. 2017; 11(2):131-137. PMC: 5421344. DOI: 10.1302/1863-2548-11-170020. View

16.

Ganz R, Huff T, Leunig M . Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009; 58:241-55. View

17.

Tayton K . Does the upper femoral epiphysis slip or rotate?. J Bone Joint Surg Br. 2007; 89(10):1402-6. DOI: 10.1302/0301-620X.89B10.19563. View

18.

Novais E, Maranho D, Vairagade A, Kim Y, Kiapour A . Smaller Epiphyseal Tubercle and Larger Peripheral Cupping in Slipped Capital Femoral Epiphysis Compared with Healthy Hips: A 3-Dimensional Computed Tomography Study. J Bone Joint Surg Am. 2019; 102(1):29-36. DOI: 10.2106/JBJS.19.00291. View

19.

Millis M . SCFE: clinical aspects, diagnosis, and classification. J Child Orthop. 2017; 11(2):93-98. PMC: 5421350. DOI: 10.1302/1863-2548-11-170025. View

20.

Goodman D, Feighan J, Smith A, Latimer B, Buly R, Cooperman D . Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997; 79(10):1489-97. DOI: 10.2106/00004623-199710000-00005. View