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Singh A, Kotzur T, Torres-Izquierdo B, Momtaz D, Gonuguntla R, Hoveidaei AH, Seifi A, Galán-Olleros M, Hosseinzadeh P. Decade-long Trends in Incidence of Slipped Capital Femoral Epiphysis in the United States: A Nationwide Database Analysis of Over 33 Million Patients. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00016. [PMID: 38775549 PMCID: PMC11111394 DOI: 10.5435/jaaosglobal-d-24-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Slipped capital femoral epiphysis (SCFE) is a prevalent pediatric hip disorder linked to severe complications, with childhood obesity as a crucial risk factor. Despite the rising obesity rates, contemporary data on SCFE's epidemiology remain scarce in the United States. This study examined SCFE incidence trends and demographic risk factors in the United States over a decade. METHODS A decade-long (2011 to 2020) retrospective cohort study was undertaken using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients aged younger than 18 years were identified and further analyzed if diagnosed with SCFE through ICD-9 or ICD-10 codes. Key metrics included demographics variables, with multivariate regression assessing demographic factors tied to SCFE, and yearly incidence calculated. RESULTS Of 33,180,028 pediatric patients, 11,738 (0.04%) were diagnosed with SCFE. The incidence escalated from 2.46 to 5.96 per 10,000 children, from 2011 to 2020, mirroring childhood obesity trends. Lower socioeconomic status children were predominantly affected. Multivariate analysis revealed reduced SCFE risk in female patients, while Black and Hispanic ethnicities, alongside the Western geographic location, had an increased risk. CONCLUSION This study underscores a twofold increase in SCFE incidence over the past decade, aligning with childhood obesity upsurge. Moreover, SCFE disproportionately affects lower SES children, with male sex, Black and Hispanic ethnicities amplifying the risk. This calls for targeted interventions to mitigate SCFE's effect, especially amidst the vulnerable populations.
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Affiliation(s)
- Aaron Singh
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Travis Kotzur
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Beltran Torres-Izquierdo
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - David Momtaz
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Rishi Gonuguntla
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Amir Human Hoveidaei
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Ali Seifi
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - María Galán-Olleros
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Pooya Hosseinzadeh
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
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Amann E, Schwarze M, Noll Y, Windhagen H, Radtke K. [Evaluation of care for slipped capital femoral epiphysis (SCFE) in Germany]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:11-22. [PMID: 37964106 PMCID: PMC10781806 DOI: 10.1007/s00132-023-04455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION The treatment concept for slipped capital femoral epiphysis is still controversial. According to studies, there is currently no recommendation for a universal approach. Therefore, the aim of this study is to analyze the care reality of children with ECF in Germany. METHODS The evaluation of the study is performed based on a questionnaire sent to physicians tending to ECF in 2021. Data is compared to the literature. RESULTS 36 of 47 questionnaires sent out were included. Overall, no significant difference in ECF care was proven in terms of annual caseload or the size of hospital. CONCLUSION A high variance in operative SCFE treatment is reported. According to current literature, the modified Dunn procedure is considered the best therapeutic option to date, especially for patients with severe or chronic ECF. However, compared with alternative care options, this is not feasible in every hospital due to its complicating and challenging nature. Central registration, minimum volume regulation, and expansion of continuing education measures can contribute to optimization.
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Affiliation(s)
- Elea Amann
- Department Kinder- und Neuroorthopädie, Orthopädische Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - Michael Schwarze
- Labor für Biomechanik und Biomaterialien, Orthopädische Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Hannover, Deutschland
| | - Yvonne Noll
- Klinisches Studienmanagement der Orthopädischen Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Hannover, Deutschland
| | - Henning Windhagen
- Orthopädische Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Hannover, Deutschland
| | - Kerstin Radtke
- Department Kinder- und Neuroorthopädie, Orthopädische Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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Smith LM, Chang Y, Feldman CH, Santacroce LM, Earle M, Katz JN, Novais EN. Public Insurance and Single-Guardian Households Are Associated with Diagnostic Delay in Slipped Capital Femoral Epiphysis. J Bone Joint Surg Am 2023; 105:1655-1662. [PMID: 37733905 PMCID: PMC10873025 DOI: 10.2106/jbjs.23.00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Extensive literature documents the adverse sequelae of delayed diagnosis of slipped capital femoral epiphysis (SCFE), including worsening deformity and surgical complications. Less is known about predictors of delayed diagnosis of SCFE, particularly the effects of social determinants of health. The purpose of this study was to evaluate the impact of insurance type, family structure, and neighborhood-level socioeconomic vulnerability on the delay of SCFE diagnosis. METHODS We reviewed medical records of patients who underwent surgical fixation for stable SCFE at a tertiary pediatric hospital from 2002 to 2021. We abstracted data on demographic characteristics, insurance status, family structure, home address, and symptom duration. We measured diagnostic delay in weeks from the date of symptom onset to diagnosis. We then geocoded patient addresses to determine their Census tract-level U.S. Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI), using U.S. Census and American Community Survey data. We performed 3 separate logistic regression models to examine the effects of (1) insurance status, (2) family structure, and (3) SVI on a delay of ≥12 weeks (reference, <12 weeks). We adjusted for age, sex, weight status, number of siblings, and calendar year. RESULTS We identified 351 patients with SCFE; 37% (129) had a diagnostic delay of ≥12 weeks. In multivariable logistic regression models, patients with public insurance were more likely to have a delay of ≥12 weeks than patients with private insurance (adjusted odds ratio [OR], 1.83 [95% confidence interval (CI), 1.12 to 2.97]; p = 0.015) and patients from single-guardian households were more likely to have a delay of ≥12 weeks than patients from multiguardian households (adjusted OR, 1.95 [95% CI, 1.11 to 3.45]; p = 0.021). We did not observe a significant increase in the odds of delay among patients in the highest quartile of overall SVI compared with patients from the lower 3 quartiles, in both the U.S. comparison (adjusted OR, 1.43 [95% CI, 0.79 to 2.58]; p = 0.24) and the Massachusetts comparison (adjusted OR, 1.45 [95% CI, 0.79 to 2.66]; p = 0.23). CONCLUSIONS The delay in diagnosis of SCFE remains a concern, with 37% of patients with SCFE presenting with delay of ≥12 weeks. Public insurance and single-guardian households emerged as independent risk factors for diagnostic delay. Interventions to reduce delay may consider focusing on publicly insured patients and those from single-guardian households. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lacey M Smith
- Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Candace H Feldman
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Immunity, and Inflammation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Leah M Santacroce
- Division of Rheumatology, Immunity, and Inflammation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Madison Earle
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Immunity, and Inflammation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eduardo N Novais
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts
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Loder RT, Gunderson Z, Sun S. Idiopathic Slipped Capital Femoral Epiphysis: Demographic Differences and Similarities between Stable, Unstable, and Valgus Types. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1557. [PMID: 37761517 PMCID: PMC10528030 DOI: 10.3390/children10091557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Idiopathic slipped capital femoral epiphysis (SCFE) is a known disorder in pre/adolescent children with vague hip/knee pain. We wished to study the demographic differences between stable varus, unstable varus, and valgus idiopathic SCFEs using a retrospective review over a 10-year period of SCFE children seen at a tertiary children's hospital. Standard demographic data was collected, and radiographs were measured to determine the Southwick angle and status of the tri-radiate cartilage. There were 190 patients; 138 had stable varus SCFEs, 45 unstable varus SCFEs, and 7 valgus SCFEs. All unstable SCFEs were varus, and all valgus SCFEs were stable. There were significant differences between the three groups by age at diagnosis, sex, race, SCFE severity, weight percentile, and duration of symptoms. The average age at diagnosis was 11.0 ± 1.2, 11.8 ± 1.8, and 12.3 ± 1.7 years for the valgus, unstable varus, and stable varus groups (p = 0.019), and similarly, SCFE severity was 25° ± 15°, 48° ± 18°, and 35° ± 19° (p = 0.0002) for the three same groups. Patients with valgus SCFEs were mostly female (86%) compared to the stable varus (39.9%) and unstable (47%) groups (p = 0.05) and mostly non-White (86%) (0.011). The duration of symptoms was 4.1 ± 4.1, 2.3 ± 5.0, and 4.5 ± 5.0 months for the valgus, unstable varus, and stable varus groups (p = 0.00005). These three types of idiopathic SCFEs demonstrated differences by age at diagnosis, sex, race, weight percentile, and duration of symptoms.
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Affiliation(s)
- Randall T. Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Pavone V, Testa G, Torrisi P, McCracken KL, Caldaci A, Vescio A, Sapienza M. Diagnosis of Slipped Capital Femoral Epiphysis: How to Stay out of Trouble? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050778. [PMID: 37238326 DOI: 10.3390/children10050778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting children and adolescents aged between 9 and 16 years, affecting approximately 10 per 100,000 children per year. The diagnosis of SCFE is often delayed, leading to an increased risk of complications. This study aims to provide the latest evidence concerning the causes of diagnostic delay and risk factors for SCFE and to educate general practitioners and paediatricians to help reduce delays in diagnosis and provide earlier therapeutic intervention. A literature search was conducted in the ScienceDirect and PubMed databases according to the PRISMA statement. Suitable studies for this systematic review included 22 articles discussing the aetiology of SCFE, risk factors, and causes of late diagnosis. Causes of delayed diagnosis include underestimation by patients, initial diagnostic approach by a non-orthopaedic professional, inadequate imaging, failure to recognize morphological changes, and variation in symptomatic presentation. The underlying risk factors for SCFE are likely part of a multifactorial process which involves anatomical variations and the metabolism of leptin, growth hormone, insulin, and other metabolic parameters. This review highlights the importance of early recognition and diagnosis of SCFE and proposes an algorithm for physicians to approach children who may have this condition.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Paola Torrisi
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | | | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatoogy, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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Ramkumar PN, Berrier AS, Helm JM, Koolmees DS, Pareek A, Krych AJ, Makhni EC, Harris JD, Nwachukwu BU. Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis. Orthop J Sports Med 2023; 11:23259671221144776. [PMID: 36655021 PMCID: PMC9841845 DOI: 10.1177/23259671221144776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/26/2022] [Indexed: 01/13/2023] Open
Abstract
Background Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources. Purpose To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS. Study Design Cohort study; Level of evidence, 3. Methods Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated. Results Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient. Conclusion Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.
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Affiliation(s)
- Prem N. Ramkumar
- Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts, USA
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
- Prem N. Ramkumar, MD, MBA, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA () (Twitter: @prem_ramkumar)
| | - Ava S. Berrier
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - J. Matthew Helm
- Department of Orthopaedic Surgery, McGovern Medical School University of Texas Health Science Center, Houston, Texas, USA
| | - Dylan S. Koolmees
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric C. Makhni
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
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Muacevic A, Adler JR, Almarshad AY, Alghamdi A, Alhussainan TS. Clinical Diagnosis of Slipped Capital Femoral Epiphysis in a Child With Negative Radiological Findings: A Case Report. Cureus 2023; 15:e33396. [PMID: 36618493 PMCID: PMC9815491 DOI: 10.7759/cureus.33396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as obesity, endocrine disorders, vitamin D deficiency, and panhypopituitarism. The diagnosis of SCFE is important especially in its early stages as this would prevent complications and delay in surgical intervention. The diagnosis is mainly done by radiological imaging and clinical evaluation. However, clinical evaluation is often overlooked. Herein, we present a case of a seven-year-old with SCFE that was diagnosed late due to negative radiological imaging and received late surgical intervention. Therefore, it is recommended that orthopedic surgeons use their clinical sense and examination skills to diagnose SCFE promptly, in order to maintain a short follow-up window to prevent any delay in surgical management and to observe for any progression, even if the radiological findings are normal.
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Purcell M, Reeves R, Mayfield M. Examining delays in diagnosis for slipped capital femoral epiphysis from a health disparities perspective. PLoS One 2022; 17:e0269745. [PMID: 35749448 PMCID: PMC9231816 DOI: 10.1371/journal.pone.0269745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Slipped Capital Femoral Epiphysis (SCFE) is a skeletal pathology affecting adolescents which requires timely surgery to prevent progression. Delays in diagnosis and treatment of SCFE can negatively affect patient prognosis, and few studies have examined how health disparities and barriers to care may influence these delays. In particular, only a handful of studies have included a Hispanic patient sample, despite this ethnic group’s increased risk for the disease and unique barriers to care. A retrospective chart review was conducted for 124 patients surgically treated for idiopathic SCFE from January 2010 to September 2017. Patient data included age, facility and date of diagnosis, sex, BMI, race and ethnicity, Southwick slip angle, and insurance type. Results indicated that patients with private insurance were more likely to present with a mild slip than patients who were insured by Medicaid or uninsured, while patients without insurance were more likely to have severe slips. Patients without insurance also had a significantly higher mean slip than patients with insurance. The relationship between insurance status and slip angle degree was significant independent of race, even though Hispanic individuals were significantly more likely to have Medicaid or be uninsured. All patients without insurance, and a majority of those with Medicaid, were diagnosed in the emergency department. Time to diagnosis and slip angle were positively correlated, which suggests that longer delays led to increase of the slip angle, consistent with previous findings. Time to diagnosis and BMI were also correlated, which may be tied to socioeconomic factors, but the possibility of weight bias should not be dismissed. These results suggest that socioeconomic status and other factors may have contributed to barriers to care which led to delays in diagnosis and thus more severe slips. Future SCFE research should include health disparities variables to better inform treatment and prognosis.
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Affiliation(s)
- Maureen Purcell
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Rustin Reeves
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
- * E-mail:
| | - Matthew Mayfield
- Department of Orthopedics, Cook Children’s Medical Center, Fort Worth, Texas, United States of America
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Loder RT, Sun S, Gunderson ZJ. Do Patient Demographics and Socioeconomic Status Influence Severity and Time to Diagnosis in Children With Stable Slipped Capital Femoral Epiphysis? J Pediatr Orthop 2022; 42:e324-e330. [PMID: 35132014 DOI: 10.1097/bpo.0000000000002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The time to diagnosis in stable slipped capital femoral epiphysis (SCFE) is often several months because of nebulous history, symptoms of knee/thigh pain, and Medicaid insurance. This study examined the impact of socioeconomic status and demographics on the time to diagnosis and SCFE severity in Indiana children. METHODS A retrospective review of all patients at a tertiary children's hospital with SCFE from January 2010 through March 2021 was performed. Standard demographic data and type of insurance was collected. Neighborhood Atlas Mapping was used to determine the state decile of the area deprivation index (ADI), a measure of socioeconomic status using 17 variables related to income, employment, education, and housing. Statistical analyses consisted of standard univariate and bivariate analyses; logistic regression analysis was used to determine predictors of a mild SCFE. A P<0.05 was considered statistically significant. RESULTS There were 142 patients; 81 male and 61 female. The average age was 12.2±1.7 years, lateral epiphyseal shaft angle of 35±19 degrees, and symptom duration of 4.5±5.0 months. There was no correlation between ADI state deciles and lateral epiphyseal shaft angle (r2=0.008) or symptom duration (r2=0.019). Insurance status and race differed by ADI deciles. In the first decile (least disadvantaged), 44% had government insurance and 89% were White; in the 10th decile (most disadvantaged), 95% had government insurance and 38% were White. Predictors of a mild SCFE were female sex [odds ratio (OR): 3.2 [1.5, 7.0]; P=0.004], symptom duration <3 months [OR: 5.3 (2.4, 11.7); P=0.00004], and White race [OR: 2.4 (1.3, 6.2); P=0.01]. Insurance status and ADI were not significant. CONCLUSIONS Contrary to other studies, neither insurance or socioeconomic status were associated with a delay in diagnosis or SCFE severity. The symptom duration in children with SCFE does not appear to be decreasing over the last several decades. Further investigation is required as to why. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Abstract
Early diagnosis of slipped capital femoral epiphysis (SCFE) is essential in order to reduce slip severity and subsequent risk of sequelae. The aims of this study were to evaluate patients' and doctors' delay in SCFE diagnosis and to identify possible factors leading to delay. We performed a retrospective review of medical charts and a personal interview with 54 consecutive patients admitted with a diagnosis of stable SCFE at three hospitals in Sweden between 2001 and 2009. Data on symptom duration, symptomatology, medical visits and type of medical contacts were retrieved. Slip angle (Southwick head-shaft angle) was measured. Median total delay from onset of symptoms to surgery was 26 weeks (range 1-109). Patients' delay was significantly longer than doctors' delay: 10 weeks (range 1-57) vs. 4 weeks (range 0-57) (P=0.002). Boys had significantly longer patients' delay than girls (13 vs. 6 weeks, P=0.021) but not doctors' delay. Children with dominance of knee pain had significantly longer doctors' delay (14 vs. 4 weeks, P=0.002) but not patients' delay. As expected, the total delay duration correlated with slip severity (R=0.59, P<0.001). Results demonstrate considerable delay in diagnosis of SCFE in Sweden, although the major cause is patients' delay. Boys and children with dominance of knee pain are more likely to be diagnosed late. Efforts to increase the awareness of SCFE directed to both the general society and healthcare providers are necessary to improve future outcomes. Level III. Retrospective comparative study.
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11
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Duncan AW, Temples HS. Slipped Capital Femoral Epiphysis: Early Intervention and Referral. J Pediatr Health Care 2021; 35:242-250. [PMID: 33714424 DOI: 10.1016/j.pedhc.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 10/22/2022]
Abstract
Slipped capital femoral epiphysis is the most common hip pathology in children aged 8-15 years old. Research has shown that when a nonorthopedic provider evaluates this patient population, there can be a significant delay in the appropriate treatment, which may have serious consequences for the prognosis of the patient. The delays are often caused by the practitioner's inability to put the clinical picture into focus with regard to how these patients typically present.. This article presents the demographics, clinical presentation, differential diagnosis, radiological and physical examination techniques, and prevention strategies to recognize this condition and provide early intervention.
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12
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The diagnosis and management of common childhood orthopedic disorders: An update. Curr Probl Pediatr Adolesc Health Care 2020; 50:100884. [PMID: 33069588 DOI: 10.1016/j.cppeds.2020.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Musculoskeletal illness represents a significant portion of office visits to primary and urgent care clinicians. Despite this, little emphasis is placed on learning pediatric orthopaedics during medical school or residency. The focus of this paper is to provide a systematic approach to this general musculoskeletal physical exam and to assist in the recognition of what conditions are normal development and what conditions require observation, workup and referral to an experienced pediatric orthopaedist.
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13
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Reply to the Letter to the Editor: What Is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared with MRI as the Gold Standard? Clin Orthop Relat Res 2020; 478:2190-2191. [PMID: 32701770 PMCID: PMC7431260 DOI: 10.1097/corr.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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14
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CORR Insights®: What is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard? Clin Orthop Relat Res 2020; 478:1060-1061. [PMID: 32217861 PMCID: PMC7170679 DOI: 10.1097/corr.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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15
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Samelis PV, Loukas C, Kantanoleon S, Lalos H, Anoua N, Kolovos P, Georgiou F, Konstantinou AL. Causes of Delayed Diagnosis of Slipped Capital Femoral Epiphysis: The Importance of the Frog Lateral Pelvis Projection. Cureus 2020; 12:e7718. [PMID: 32431996 PMCID: PMC7234041 DOI: 10.7759/cureus.7718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Delayed diagnosis and treatment is a universally reported problem that impairs the prognosis of slipped capital femoral epiphysis (SCFE). Quite frequently, a delayed diagnosis of SCFE is observed in spite of serial admissions and examinations of the limping adolescent. Why do health professionals globally fail to make a definitive diagnosis of SCFE during the first examination of the patient? A retrospective study of 36 adolescents treated for stable SCFE and two adolescents treated for unstable SCFE has been performed. In more than half of the delayed diagnosed stable slips (13/25, 52%), the diagnosis was set after serial examinations of the patient. Health professionals commonly order only the anteroposterior (AP) X-ray view of the pelvis when examining a non-traumatic limping adolescent. The frog lateral (FL) projection is usually spared in an attempt to limit the radiation exposure of the patient, especially in ambulating adolescents with mild symptoms. It is proposed that in the non-traumatic limping adolescent, the FL projection instead of the AP pelvis view should be requested by the health professional in order to timely diagnose a surgical emergency of the adolescent hip such as SCFE.
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Affiliation(s)
- Panagiotis V Samelis
- First Orthopaedic Department, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC.,Orthopaedics, Orthopaedic Research and Education Center, Attikon University Hospital, Athens, GRC
| | - Christos Loukas
- Orthopaedics, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
| | | | - Harris Lalos
- Sports Medicine, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
| | - Nikolaos Anoua
- Orthopaedics, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
| | - Panagiotis Kolovos
- Orthopaedics, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
| | - Flourentzos Georgiou
- Orthopaedics, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
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Bittersohl D, Bittersohl B, Westhoff B, Krauspe R. [Slipped capital femoral epiphysis: clinical presentation, diagnostic procedure and classification]. DER ORTHOPADE 2019; 48:651-658. [PMID: 31253995 DOI: 10.1007/s00132-019-03767-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is a frequent chronic and often bilateral atraumatic slippage of the epiphysis relative to the femoral neck in adolescence. The success of the treatment depends on the extent of the slippage and possible complications. OBJECTIVES Review on current trends in clinical examination and diagnostic imaging protocols. Commonly used imaging techniques, methods of measuring the slippage and treatment-relevant classification schemes are presented. MATERIALS AND METHODS An overview on the clinical findings, the diagnostic procedures and the classification of SCFE based on relevant study results and experience gained in our daily clinical practice. RESULTS Early diagnosis of SCFE is essential, as a delay in diagnosis regularly leads to an increase in slippage with an increased risk of subsequent damage to the blood vessels, which can lead to irreversible damage of the joint. Symptoms and findings are frequently subtle and nonspecific, often leading to delay in diagnosis and treatment and, consequently, to the manifestation of massive deformities. X‑ray imaging is the primary imaging modality, whereas MRI, computed tomography (CT) and ultrasound are helpful in surgical planning and prognostic evaluation. Postoperatively, they provide information on short and long-term complications. DISCUSSION The delay in the diagnosis of SCFE is still present in the literature as well as in our own patient population, indicating that a repeated, consistent training on this topic is essential to prevent harm to patients. Whether patients benefit from advanced imaging techniques such as MRI or CT is questionable and should be screened case by case.
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Affiliation(s)
- D Bittersohl
- Klinik für Orthopädie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - B Bittersohl
- Klinik für Orthopädie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - B Westhoff
- Klinik für Orthopädie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - R Krauspe
- Klinik für Orthopädie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
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17
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Fernandez FF, Eberhardt O, Wirth T. [Early and late complications and their management in slipped capital femoral epiphysis]. DER ORTHOPADE 2019; 48:677-684. [PMID: 31025044 DOI: 10.1007/s00132-019-03729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) remains a challenge for the treating surgeon. First of all, SCFE should be diagnosed as early as possible. The earlier the diagnosis is made in adolescents, the lower the slip angle will be. Mild slips show more favourable long-term courses than moderate and severe SCFE. COMPLICATIONS With increasing slip angle, the risk of complications increases. The complications of SCFE are diverse, the most severe of which are avascular necrosis (AVN) and chondrolysis. AVN is more common in surgically treated than in non-operatively managed patients and unstable SCFE bears the highest risk of AVN. THERAPY Adequate treatment of AVN is still controversial. For surgical treatments, variable rates of AVN have been reported. There is a wide spectrum of surgeries for treating AVN, from hip joint-preserving techniques to total hip replacement. In central Europe there is wide consensus in favour of treating the contralateral side, but this is not without complications. Surgical treatment with in-situ pinning must be carried out with great care to take into consideration the morphology of the femoral head and not to perforate it. It should always be ensured that no osteosynthesis material penetrates the hip joint.
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Affiliation(s)
- F F Fernandez
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland.
| | - O Eberhardt
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
| | - T Wirth
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
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18
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Mofidi J, Sarkisova N, Andras LM, Goldstein RY, Zaslow TL, Edison BR, Skaggs DL, Bent MA. A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis. Glob Pediatr Health 2019; 6:2333794X19862127. [PMID: 31309132 PMCID: PMC6613050 DOI: 10.1177/2333794x19862127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction. The purpose of this study was to identify deficiencies in pediatric residents’ and pediatricians’ knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs (P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs (P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions (P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.
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19
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Uvodich M, Schwend R, Stevanovic O, Wurster W, Leamon J, Hermanson A. Patterns of Pain in Adolescents with Slipped Capital Femoral Epiphysis. J Pediatr 2019; 206:184-189.e1. [PMID: 30454962 DOI: 10.1016/j.jpeds.2018.10.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/08/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively characterize pain locations in slipped capital femoral epiphysis (SCFE) and evaluate pain locations as predictors of a delay in diagnosis. STUDY DESIGN This was an institutional review board approved prospective study of 110 children who underwent surgery for SCFE at a tertiary children's hospital between 2009 and 2015. Standardized pain diagrams were completed by 107 children. Pain zones were designated via a composite diagram. Hips without hip pain were categorized as atypical; hips with hip pain were typical. RESULTS In total, 122 hips were eligible for pain zone analysis. Seventy hips (57.4%) had hip pain. Atypical pain was present in 52 hips (42.6%), which included groin pain in 17 hips (13.9%), thigh/leg pain in 43 (35.2%), knee pain in 32 (26.2%), and posterolateral pain of the hip and leg in 13 (10.7%). A combination of pain zones was present in 48 hips (39.3%). Forty-nine percent of patients had more than 1 visit until diagnosis. The three most common pain locations for typical hips were hip, hip/thigh, and hip/knee pain (77.2% of typical hips). The 3 most common pain locations for atypical hips were isolated thigh, knee, and groin (65.4% of atypical hips). The least common pain presentations had a longer duration of symptoms (P = .04) and more healthcare visits before diagnosis (P = .04). CONCLUSIONS A combination of pain locations is common in SCFE. Less frequent pain presentations may delay diagnosis. Delays in diagnosis continue despite education efforts.
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Affiliation(s)
- Mason Uvodich
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.
| | - Richard Schwend
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Ognjen Stevanovic
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Will Wurster
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Julia Leamon
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Alec Hermanson
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
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20
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Nielsen E, Andras LM, Skaggs DL. Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers. Spine Deform 2019; 6:263-266. [PMID: 29735135 DOI: 10.1016/j.jspd.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/07/2017] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective single center. OBJECTIVE Our purpose was to quantify the time to diagnosis of spondylolysis/spondylolisthesis in symptomatic patients after first seeking medical care. SUMMARY OF BACKGROUND DATA Several studies have found a high prevalence of pars defects in adolescent athletes with back pain, up to 47%. A review by the Scoliosis Research Society Evidence-Based Medicine Committee reports that both nonsurgical and surgical treatment of symptomatic spondylolysis effectively relieves pain and allows most patients to return to activities. Nonoperative treatment outcomes improve with early diagnosis. METHODS A retrospective chart review was conducted of patients presenting at our institution between 2005 and 2015 with symptomatic spondylolysis or spondylolisthesis with radiographic confirmation. Medical records were reviewed for demographics, date of symptom onset, date of initial presentation to a health care provider, type of provider, and date of diagnosis. RESULTS Forty-six patients met the inclusion criteria. Average patient age was 14 years (range: 6-19 years). Forty-one percent (19/46) of patients had spondylolysis, and 59% (27/46) of patients had spondylolisthesis. Of those with spondylolisthesis, 20 had grade I, 4 had grade II, 2 had grade III, and 1 had grade IV slips. The average time between onset of symptoms and initial presentation was 24 weeks (orthopedic: 21 weeks, nonorthopedic: 29 weeks, unknown: 18 weeks; p = .26). The average delay between initial presentation to a health care provider and diagnosis was 15 weeks. Time from initial presentation to diagnosis was 1 week for orthopedic surgeons, 25 weeks for nonorthopedic providers, and 10 weeks for unknown providers; this difference was significant (p = .02). CONCLUSION Diagnosis of spondylolysis/spondylolisthesis was significantly longer after seeing a nonorthopedic versus an orthopedic provider. Education of primary care providers on this topic is warranted. Children suffering from back pain from spondylolysis/spondylolisthesis may benefit from early referral to an orthopedic surgeon. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ena Nielsen
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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21
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Karkenny AJ, Tauberg BM, Otsuka NY. Pediatric Hip Disorders: Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes Disease. Pediatr Rev 2018; 39:454-463. [PMID: 30171056 DOI: 10.1542/pir.2017-0197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Alexa J Karkenny
- Montefiore Medical Center and the Children's Hospital at Montefiore, Bronx, NY
| | - Brandon M Tauberg
- Montefiore Medical Center and the Children's Hospital at Montefiore, Bronx, NY
| | - Norman Y Otsuka
- Montefiore Medical Center and the Children's Hospital at Montefiore, Bronx, NY
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22
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Abstract
Slipped capital femoral epiphysis (SCFE) is one of the most common hip pathologies that occurs during adolescence, and its incidence has been increasing over the past decades. For this reason, pediatricians should be aware of this entity to ensure an early diagnosis and intervene in a timely manner. The typical patient with SCFE is an adolescent who is obese presenting with hip pain, but it can also occur in children who are not obese; therefore, SCFE should be part of the differential diagnosis in any skeletally immature patient presenting with hip or knee pain. This article provides an overview for the clinician of relevant aspects of this disease that can lead to serious long-term consequences if not diagnosed and treated appropriately. [Pediatr Ann. 2018;47(9):e377-e380.].
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23
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Lam A, Boenerjous SA, Lo Y, Abzug JM, Kurian J, Liszewski MC, Sanderson DE, Scholnick JM, Taragin BH, Gomez JA, Otsuka NY, Hanstein R. Diagnosing slipped capital femoral epiphysis amongst various medical specialists. J Child Orthop 2018; 12:160-166. [PMID: 29707055 PMCID: PMC5902750 DOI: 10.1302/1863-2548.12.170200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate sensitivity, specificity and accuracy of a radiographic slipped capital femoral epiphysis (SCFE)-diagnosis among medical specialists. METHODS Three paediatricians, three paediatric radiologists and three paediatric orthopaedic surgeons completed two rounds of a survey of anteroposterior and frog-leg lateral radiographs of patients with a diagnosis of SCFE (25), femoroacetabular impingement (four), Legg-Calvé-Perthes (11) or no hip pathology (ten). Intra- and interobserver agreement among specialties regarding the diagnosis of a SCFE were assessed using Cohen's kappa coefficient (κ). Diagnostic accuracy of SCFE relative to the benchmark, a combination of the radiographic diagnosis based on Klein's line, clinical symptoms and surgical treatment, was assessed computing sensitivity, specificity and accuracy. RESULTS Intraobserver agreement between the surveys was moderate among paediatricians (κ-range, 0.44 to 0.52), moderate to almost perfect among orthopaedic surgeons (κ-range, 0.79 to 0.88) and almost perfect among paediatric radiologists (κ-range, 0.83 to 1.00). Interobserver agreement for survey 1 and 2 was slight among paediatricians (mean κ, 0.19), substantial among orthopaedic surgeons (mean κ, 0.77) and almost perfect among paediatric radiologists (mean κ, 0.86). Sensitivity of SCFE-diagnosis was high among radiologists and orthopaedic surgeons (88% to 100% for both specialties), but lower for paediatricians (24% to 76%). Specificity was high among radiologists and orthopaedic surgeons (72% to 84%), however, variable among paediatricians (56% to 80%). Accuracy of a SCFE-diagnosis was highest in radiologists (84% to 92%), followed by orthopaedic surgeons (80% to 88%) and paediatricians (48% to 78%). CONCLUSION SCFE can be detected on radiographs by different medical specialties. Intra- and interobserver agreement, specificity, sensitivity and accuracy for radiographic SCFE-diagnosis amongst paediatric radiologists and orthopaedic surgeons are better than that of general paediatricians. LEVEL OF EVIDENCE II.
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Affiliation(s)
- A. Lam
- Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - S. A. Boenerjous
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, New York, USA
| | - Y. Lo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - J. M. Abzug
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J. Kurian
- Department of Radiology, Paediatric Radiology, Montefiore Medical Center, Bronx, New York, New York, USA
| | - M. C. Liszewski
- Department of Radiology, Paediatric Radiology, Montefiore Medical Center, Bronx, New York, New York, USA
| | - D. E. Sanderson
- Department of Paediatrics, General Paediatrics, Montefiore Medical Center, Bronx, New York, New York, USA
| | - J. M. Scholnick
- Department of Paediatrics, General Paediatrics, Montefiore Medical Center, Bronx, New York, New York, USA
| | - B H. Taragin
- Department of Radiology, Paediatric Radiology, Montefiore Medical Center, Bronx, New York, New York, USA
| | - J. A. Gomez
- Division of Paediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, New York, New York, USA
| | - N. Y. Otsuka
- Division of Paediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, New York, New York, USA
| | - R. Hanstein
- Division of Paediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, New York, New York, USA, Correspondence should be sent to Regina Hanstein, 3400 Bainbridge Ave, MAP 6th floor, Bronx, NY 10467, United States. E-mail:
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Perry DC, Metcalfe D, Costa ML, Van Staa T. A nationwide cohort study of slipped capital femoral epiphysis. Arch Dis Child 2017; 102:1132-1136. [PMID: 28663349 PMCID: PMC5754864 DOI: 10.1136/archdischild-2016-312328] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/22/2017] [Accepted: 05/17/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To describe the epidemiology of slipped capital femoral epiphysis (SCFE), to examine associations with childhood obesity and socioeconomic deprivation, and to explore factors associated with diagnostic delays. DESIGN Historic cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics. SETTING All contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service. PATIENTS All individuals <16 years old with a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the UK between 1990 and 2013. MAIN OUTCOME MEASURES Annual incidence, missed opportunities for diagnosis and diagnostic delay. RESULTS Over the 23-year period the incidence remained constant at 4.8 (95% CI 4.4 to 5.2) cases per 100,000 0-16-year-olds. There was a strong association with socioeconomic deprivation. Predisease obesity was also strongly associated with SCFE; mean predisease z-score of body mass index was 1.43 (95% CI 1.20 to 1.68) compared with the UK reference mean. Diagnostic delays were common, with most children (75.4%) having multiple primary care contacts with relevant symptomatology, and those who presented with knee pain having significantly longer diagnostic delay (median 161 (IQR 27-278) days) than those with hip pain (20 (5-126)) or gait abnormalities (21 (7-72)). CONCLUSIONS SCFE has a strong association with both area-level socioeconomic deprivation and predisease obesity. The majority of patients with SCFE are initially misdiagnosed and those presenting with knee pain are particularly at risk.
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Affiliation(s)
- Daniel C Perry
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Tjeerd Van Staa
- Health eResearch Centre, University of Manchester, Manchester, UK
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