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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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Firman N, Homer K, Harper G, Robson J, Dezateux C. Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records. Arch Dis Child 2024; 109:414-421. [PMID: 38471744 DOI: 10.1136/archdischild-2023-326407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity. DESIGN Longitudinal SETTING: 285 north-east London general practitioners (GPs). PARTICIPANTS 63 418 (50.9% boys) Reception and 55 364 (50.8% boys) Year 6 National Child Measurement Programme (NCMP) participants, linked to GP electronic health records (EHRs). MAIN OUTCOME MEASURE A GP consultation with a recorded musculoskeletal symptom or diagnosis. METHODS We calculated proportions with a musculoskeletal consultation by ethnic-adjusted weight status (underweight <2nd; overweight ≥91st; obese ≥98th centile), sex, ethnicity, and area-level deprivation. We estimated mutually-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) using Cox's proportional regression models stratified by school year and sex. RESULTS We identified 1868 (3.0%) Reception and 4477 (8.1%) Year 6 NCMP participants with at least one musculoskeletal consultation. In adjusted analyses, Reception year girls with a body mass index (BMI) classified as overweight (HR 1.24, 95% CI 1.02 to 1.52) or obese (HR 1.67, 95% CI 1.35 to 2.06) were more likely to have at least one musculoskeletal consultation. Year 6 girls with obesity were more likely (HR 1.20, 95% CI 1.07 to 1.35), and boys with a BMI in the underweight range were less likely (HR 0.39, 95% CI 0.21 to 0.73), to have a musculoskeletal consultation. CONCLUSIONS Girls living with obesity at the start or end of primary school are more likely to attend their GP for a musculoskeletal consultation. Routine linkage of NCMP data to EHRs provides useful insights into childhood health conditions related to excess weight in early childhood. Recognition of obesity as a contributing factor for musculoskeletal symptoms may inform clinical management, particularly in girls.
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Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Zusman NL, Goldstein RY, Yoo JU. Quantifying Risk Factors for Slipped Capital Femoral Epiphysis and Postslip Osteonecrosis. J Pediatr Orthop 2024; 44:e30-e34. [PMID: 37773028 DOI: 10.1097/bpo.0000000000002539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is a disorder of the proximal femoral physis occurring in late childhood and adolescence. Previously postulated risk factors include obesity and endocrinopathies. The purpose of this investigation was to identify risk factors for developing SCFE, as well as postslip osteonecrosis (ON), among the United States pediatric population. METHODS A national database investigation was performed using PearlDiver Technologies, Inc., queried for SCFE and ON using International Classification of Disease codes (2010 to 2020). Regression analyses to determine the risk of developing a SCFE, and ON after a patient has already been diagnosed with a SCFE ("postslip"). Propensity matching between SCFE and control groups generated a pseudo-randomization model to compare the relative risk. RESULTS There were 11,465 patients with SCFE available in the database, matched with 134,680 controls. After matching, vitamin D deficiency, obesity, hypothyroidism, and growth hormone use were risk factors for developing SCFE [relative risk ranges from 1.42 (95% CI: 1.21-1.39, vitamin D deficiency) to 3.45 (95% CI: 3.33-3.57, obesity)]. ON risk factors were vitamin D deficiency [1.65 (1.26-2.14)] and hypothyroidism [1.49 (1.10-2.07)]. CONCLUSIONS This United States national database study quantified risk factors of developing an SCFE and postslip ON. Obesity is the most significant risk factor for the development of a slip, but not ON. Growth hormone use, hypothyroidism, and vitamin D deficiency are also risk factors for SCFE development, whereas only the latter two were associated with ON. These findings demonstrate the public health implications of obesity and comorbid conditions in pediatric hip pathology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Natalie L Zusman
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Rachel Y Goldstein
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jung U Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
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Nicolini AP, Kuga CT. Epiphysiolysis in a 22-year-old Patient with Congenital Hypogonadotropic Hypogonadism: Case Report. Rev Bras Ortop 2023; 58:e960-e963. [PMID: 38077755 PMCID: PMC10708964 DOI: 10.1055/s-0041-1726071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
Epiphysiolysis is a relatively common disease in the adolescent population (9-16 years); however, it is rare in the adult population. It is characterized by non-traumatic proximal femur slipping. When it occurs in this population it is associated with some disease that slows sexual development and physis closure, such as endocrine diseases or brain tumors. The aim of the present study is to report a case of epiphysiolysis in a 22-year-old patient with hypogonadotropic hypogonadism. There are only 63 cases reported in the world literature on epiphysiolysis in the adult population.
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Affiliation(s)
- Alexandre Pedro Nicolini
- Médico ortopedista e traumatologista, Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Claudio Takashi Kuga
- Médico ortopedista e traumatologista, Departamento de Ortopedia e Traumatologia, Hospital Geral de Pedreira, São Paulo, SP, Brasil
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Ripatti L, Kauko T, Kytö V, Rautava P, Sipilä J, Lastikka M, Helenius I. The incidence and management of slipped capital femoral epiphysis: a population-based study. Acta Orthop Belg 2023; 89:634-638. [PMID: 38205753 DOI: 10.52628/89.4.9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku University Hospital patient charts were analyse for the incidence of SCFE in 2004-2012, the length of stay, and the type of surgery with respect to age, gender, study year, and season. The reoperations and rehospitalisations in 2004-2014 for SCFE were analysed for 2-10 years after surgery. In 2004 to 2012, primary surgery for SCFE was performed for 126 children. The average annual incidence of SCFE was 1.06/100 000 (95% confidence interval [CI], 0.81-1.38) in girls and 1.35/100 000 (95% CI 1.07-1.70) in boys. The median age at surgery was lower in girls than in boys (11 and 13 years, respectively, p<0.0001). During the study period, there was no significant change in the incidence of SCFE (p=0.9330), the type of primary procedures performed (p=0.9988), or the length of stay after the primary procedure (p=0.2396). However, the length of stay after percutaneous screw fixation was shorter compared with open reduction and fixation (mean 3.4 and 7.9 days, respectively, p<0.0001). There was no significant difference in the rate of reoperations according to the type of primary surgery. In conclusion, the incidence of SCFE and the proportion of different primary surgeries have recently remained stable in Finland.
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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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Chatziravdeli V, Psaroulaki E, Rodiftsis G, Katsaras G. Slipped Capital Femoral Epiphysis Pathogenesis and Its Relation to Obesity—Where Do We Stand? A Narrative Review. SURGERIES 2023. [DOI: 10.3390/surgeries4020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder in children 9–15 years old with an incidence that ranges from 0.33:100,000 to 24.58:100,000. Idiopathic SCFE is strongly associated with obesity, while atypical SCFE is associated with endocrinopathies, metabolic and renal disease, radiation therapy, and chemotherapy. In this review, we summarized the current data regarding the pathogenesis of SCFE and its association to obesity. In the last years, there have been increasing evidence regarding the implication of obesity in the pathogenesis of SCFE, but no definitive mechanism has been proven. The etiology is probably multifactorial, with both mechanical and metabolic factors contributing to the disease, with the later gaining more ground, especially in obese patients. Understanding what causes the disease will help paediatricians and orthopaedists develop more efficient strategies for treating patients and diminishing complication rates.
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Affiliation(s)
- Vasiliki Chatziravdeli
- Orthopaedic Department, “Ippokrateio” Hospital of Thessaloniki, 54643 Thessaloniki, Greece
| | - Evdokia Psaroulaki
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
| | - Grigoriοs Rodiftsis
- Orthopaedic Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
| | - Georgios Katsaras
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
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Slipped Capital Femoral Epiphysis, Food Deserts, Poverty, and Urban/Rural Residence: Is There a Link? J Pediatr Orthop 2023; 43:e230-e235. [PMID: 36730127 DOI: 10.1097/bpo.0000000000002315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Childhood obesity is increased in food deserts, a community with little to no access to healthy food. As obesity is associated with slipped capital femoral epiphysis (SCFE), it was the purpose of this study to analyze the prevalence of SCFE patients by food desert location and its interaction with rural/urban location. METHODS A retrospective review of all consecutive patients with idiopathic SCFE treated at our institution over 11 years was performed. From the patient's address, the US Census Bureau tract in which the patient resided was determined. Using the census tract code, it was ascertained if the patient lived in a food desert and urban or rural location. Standard statistical analyses were performed; a P <0.05 was considered statistically significant. RESULTS There were 177 SCFE patients: 79 girls, 98 boys, 106, White, and 69 nonWhite. The average age at diagnosis was 12.1±1.7 years, the average symptom duration 4.1±5.1 months, and the average weight percentile 94±10. Of these 177 patients, 26.5% lived in a food desert, which was higher than the expected 17.5% ( P =0.023). Those living in a food desert were more commonly nonWhite (60% vs. 32%, P =0.0014). There were 25% from rural areas and 75% from urban areas. No rural SCFE patients lived in food deserts whereas 34% of urban patients lived in food deserts. The average poverty rate of the SCFE patient census tracts was 19%, no greater than the expected 15% ( P =0.32). SCFE patients living in rural census tracts had a lower poverty rate ( P <10 -6 ). CONCLUSIONS There is a correlation with the prevalence of SCFE patients by residence in a "food desert", but not with rural/urban locale or poverty status in Indiana. Further research will be needed to see if these findings apply to other states within the United States and other parts of the world. LEVEL OF EVIDENCE III.
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Ben Tahar S, Garnier J, Eller K, DiMauro N, Piet J, Mehta S, Bajpayee AG, Shefelbine SJ. Adolescent obesity incurs adult skeletal deficits in murine induced obesity model. J Orthop Res 2023; 41:386-395. [PMID: 35578981 DOI: 10.1002/jor.25378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/06/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Adolescent obesity has risen dramatically in the last few decades. While adult obesity may be osteoprotective, the effects of obesity during adolescence, which is a period of massive bone accrual, are not clear. We used a murine model of induced adolescent obesity to examine the structural, mechanical, and compositional differences between obese and healthy weight bone in 16-week-old female C57Bl6 mice. We also examined the effects of a return to normal weight after skeletal maturity (24 weeks old). We found obese adolescent bone exhibited decreased trabecular bone volume, increased cortical diameter, increased ultimate stress, and increased brittleness (decreased plastic energy to fracture), similar to an aging phenotype. The trabecular bone deficits remained after return to normal weight after skeletal maturity. However, after returning to normal diet, there was no difference in ultimate stress nor plastic energy to fracture between groups as the normal diet group increased ultimate stress and brittleness. Interestingly, compositional changes appeared in the former high-fat diet mice after skeletal maturity with a lower mineral to matrix ratio compared to normal diet mice. In addition there was a trend toward increased fluorescent advanced glycation endproducts in the former high-fat diet mice compared to normal diet mice but this did not reach significance (p < 0.05) due to the large variability. The skeletal consequences of adolescent obesity may have lasting implications for the adult skeleton even after return to normal weight. Given the rates of adolescent obesity, skeletal health should be a concern.
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Affiliation(s)
- Soha Ben Tahar
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Julien Garnier
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Kerry Eller
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Nicole DiMauro
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Judith Piet
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Shihkar Mehta
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Ambika G Bajpayee
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, USA
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Beharry AC, Quan Soon CH, Augustus M, Toby D, Thomas D. Increasing incidence of slipped capital femoral epiphysis in Trinidad and Tobago: A 50-year review. Trop Doct 2023; 53:85-90. [PMID: 36214270 DOI: 10.1177/00494755221130562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Slipped Capital Femoral Epiphysis (SCFE) is a physeal disorder of the proximal femur. Misdiagnosis and late treatment are associated with poorer outcomes. The epidemiology and delays in treatment of the disease between 1968 and 2018 were investigated in North Trinidad. The number of cases presenting annually has increased over the decades and the incidence between 2008-2018 was 2.2 cases per 100 000 per year. Almost 70% of cases were above the 95th percentile for body weight. Delay in treatment from onset of symptoms was 278 ± 258 days. Awareness of the risk factors and clinical presentation of SCFE may facilitate early diagnosis and treatment, and prevent severe hip disability in adulthood.
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Affiliation(s)
- Allan C Beharry
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad
| | - Camille H Quan Soon
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad.,Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad
| | - Megan Augustus
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad
| | - David Toby
- Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad
| | - Dylan Thomas
- Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad.,Department of Surgery, 63084San Fernando General Hospital, San Fernando, Trinidad
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Cotton EV, Fowler SC, Maday KR. A review of slipped capital femoral epiphysis. JAAPA 2022; 35:39-43. [PMID: 36412940 DOI: 10.1097/01.jaa.0000892720.49955.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT Hip pain in children is common, with causes ranging from the benign to destructive. This article reviews slipped capital femoral epiphysis (SCFE), one of the most common hip pathologies in preadolescents and adolescents, which often is missed or delayed in diagnosis because of its vague, atypical presentation.
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Affiliation(s)
- Emma V Cotton
- At the time this article was written, Emma V. Cotton was a student in the PA program and Samuel C. Fowler was a medical student at the University of Tennessee in Memphis, Tenn. Kristopher R. Maday is program director and an associate professor in the PA program at the University of Tennessee. The authors have disclosed no potential conflicts of interest, financial or otherwise
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13
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Avascular Necrosis and Time to Surgery for Unstable Slipped Capital Femoral Epiphysis: A Systematic Review and Meta-analysis. J Pediatr Orthop 2022; 42:545-551. [PMID: 35941089 DOI: 10.1097/bpo.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) is a well-known complication of unstable slipped capital femoral epiphysis (SCFE) and its cause is multifactorial. Higher AVN rates have been reported with surgery undertaken between 24 hours to 7 days from the onset of symptoms. The current evidence regarding time to surgery and AVN rate remains unclear. The aim of our study was to investigate the rate of AVN and time to surgery in unstable SCFE. METHODS A literature search of several databases was conducted. Eligibility criteria included all studies that reported AVN rates and time to surgery in unstable SCFE patients. We performed a meta-analysis using a random-effects model to pool the rate of AVN in unstable SCFE using different time to surgery subgroups (≤24 h, 24 h - 7 d and >7 d). Descriptive, quantitative and qualitative data were extracted. RESULTS Twelve studies matched our eligibility criteria. In total, there were 434 unstable SCFE of which 244 underwent closed reduction (CR). The pooled AVN rates were 24% [95% CI: 16%-35%] and 29% [95% CI: 16%-45%] for the total and CR groups, respectively. The highest AVN rates were with surgery between 24 hours to 7 days, 42% and 54% for the total and CR groups, respectively. The lowest rates of AVN were with time to surgery ≤24 hours (22% and 21% respectively) and >7 days (18% and 29% respectively). These differences were not statistically significant. There was significant subgroup heterogeneity which was highest in the 24 hours - 7 days subgroup and lowest in the >7 days subgroup. CONCLUSIONS The cumulative evidence was not conclusive for an association between AVN rate and time to surgery. The overall AVN rates were lower in unstable SCFE patients who had surgery ≤24 hours and >7 days. However, treatment techniques were very variable and there was significant heterogeneity in the included studies. Multi-centre prospective studies are required with well-defined time to surgery outcomes. LEVEL OF EVIDENCE Level III/IV.
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14
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Nagpal N, Messito MJ, Katzow M, Gross RS. Obesity in Children. Pediatr Rev 2022; 43:601-617. [PMID: 36316265 DOI: 10.1542/pir.2021-005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
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Affiliation(s)
- Nikita Nagpal
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Michelle Katzow
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Rachel S Gross
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
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15
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Cuda SE, Kharofa R, Williams DR, O'Hara V, Conroy R, Karjoo S, Paisley J, Censani M, Browne NT. Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100031. [PMID: 37990723 PMCID: PMC10662000 DOI: 10.1016/j.obpill.2022.100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age. Conclusions This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Valerie O'Hara
- WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, Pediatric Gastroenterology, 501 6th Ave S St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street, Lawrenceburg, IN, 47025-2048, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
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16
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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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17
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Jardaly A, Torrez TW, McGwin G, Gilbert SR. Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease: A database study. World J Orthop 2022; 13:373-380. [PMID: 35582157 PMCID: PMC9048495 DOI: 10.5312/wjo.v13.i4.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting. Two recent examples include slipped capital femoral epiphysis (SCFE) and Blount’s disease. Surgical indications are well-studied for each pathology, but to our knowledge, there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition. We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.
AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.
METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics, rates of complications, and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.
RESULTS Total 1788 SCFE database entries were included, 30% were performed in an outpatient setting. In situ pinning was used in 98.5% of outpatient surgeries and 87.8% of inpatient surgeries (P < 0.0001). Inpatients had a greater percent of total complications than outpatients 2.57% and 1.65% respectively. Regarding Blount’s disease, outpatient surgeries constituted 41.2% of the 189 procedures included in our study. The majority of inpatients were treated with a tibial osteotomy, while the majority of outpatients had a physeal arrest (P < 0.0001). Complications were encountered in 7.4% of patients, with superficial surgical site infections and wound dehiscence being the most common. 1.6% of patients had a readmission. No differences in complication and readmission risks were found between inpatients and outpatients.
CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting. This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions. Osteotomies are more commonly performed in an inpatient setting where monitoring is available.
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Affiliation(s)
- Achraf Jardaly
- Department of Orthopaedics, Hughston Foundation/Hughston Clinic, Columbus, GA 31909, United States
| | - Timothy W Torrez
- Department of Orthopedics, University of Alabama, Birmingham, AL 35205, United States
| | - Gerald McGwin
- Department of Epidemiology, Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL 35205, United States
| | - Shawn R Gilbert
- Department of Pediatric Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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18
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Perry DC, Arch B, Appelbe D, Francis P, Craven J, Monsell FP, Williamson P, Knight M. The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain. Bone Joint J 2022; 104-B:519-528. [PMID: 35360942 PMCID: PMC9020520 DOI: 10.1302/0301-620x.104b4.bjj-2021-1709.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE). METHODS This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. RESULTS A total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define 'at risk'. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE. CONCLUSION The experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials. Cite this article: Bone Joint J 2022;104-B(4):519-528.
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Affiliation(s)
- Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Trauma and Orthopaedics Department, Alder Hey Children's Hospital, Liverpool, UK.,Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Barbara Arch
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Duncan Appelbe
- Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Priya Francis
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joanna Craven
- North West School of Surgery, Health Education England, Liverpool, UK
| | | | - Paula Williamson
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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19
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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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20
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Manglunia A, Goyal R, Behera HB, Mangaraj S. Hypothyroidism Presenting as Slipped Capital Femoral Epiphysis. J Paediatr Child Health 2022; 58:737-738. [PMID: 35218254 DOI: 10.1111/jpc.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ankit Manglunia
- Department of Endocrinology, IMS and SUM Medical College and Hospital, Bhubaneswar, India
| | - Raghav Goyal
- Department of Orthopedics, IMS and SUM Medical College and Hospital, Bhubaneswar, India
| | - Himanshu B Behera
- Department of Orthopedics, IMS and SUM Medical College and Hospital, Bhubaneswar, India
| | - Swayamsidha Mangaraj
- Department of Endocrinology, IMS and SUM Medical College and Hospital, Bhubaneswar, India
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21
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Wadström MG, Hailer NP, Hailer YD. No increased mortality after total hip arthroplasty in patients with a history of pediatric hip disease: a matched, population-based cohort study on 4,043 patients. Acta Orthop 2021; 92:673-677. [PMID: 34392791 PMCID: PMC8635541 DOI: 10.1080/17453674.2021.1963582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patients with pediatric hip diseases are more comorbid than the general population and at risk of premature, secondary osteoarthritis, often leading to total hip arthroplasty (THA). We investigated whether THA confers an increased mortality in this cohort.Patients and methods - We identified 4,043 patients with a history of Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), or developmental dysplasia of the hip (DDH) in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2012. For each patient, we matched 5 controls from the general population for age, sex, and place of residence, and acquired information on all participants' socioeconomic background and comorbidities. Mortality after THA was estimated according to Kaplan-Meier, and Cox proportional hazard models were fitted to estimate adjusted hazard ratios (HRs) for the risk of death.Results - Compared with unexposed individuals, patients exposed to a THA due to pediatric hip disease had lower incomes, lower educational levels, and a higher degree of comorbidity but a statistically non-significant attenuation of 90-day mortality (HR 0.9; 95% CI 0.4-2.0) and a lower risk of overall mortality (HR 0.8; CI 0.7-0.9).Interpretation - Patients exposed to THA due to a history of pediatric hip disease have a slightly lower mortality than unexposed individuals. THA seems not to confer increased mortality risks, even in these specific patients with numerous risk factors.
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Affiliation(s)
- Miriam G Wadström
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Sweden,Correspondence:
| | - Nils P Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Sweden
| | - Yasmin D Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Sweden
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22
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Mills H, Flowers MJ, Agrawal Y, Nicolaou N. Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study. J Pediatr Orthop B 2021; 30:540-548. [PMID: 32932415 DOI: 10.1097/bpb.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most common treatment for slipped capital femoral epiphysis worldwide is in situ fixation with a threaded screw. Un-threaded screws are designed to prevent slip progression without hindering residual growth of the proximal femur. This study aimed to compare growth, remodelling and long-term outcomes after fixation with un-threaded screws and a matched cohort of patients treated with a standard screw. Six patients (nine hips) treated with un-threaded screws and 16 patients (21 hips) treated with standard screws matched for age, skeletal maturity, sex and Southwick angle were recruited. Clinical records were reviewed for patient demographics, medical history and complications. Radiographs were reviewed for residual growth and time to physeal closure. Growth velocity was calculated. Absence of cam deformity signified complete remodelling. Clinical assessment was graded from excellent to poor and patient-reported outcomes were recorded. There was significantly more growth recorded in the un-threaded screw group in femoral neck length (7.6 mm, P = 0.003), articulo-lesser trochanter distance (5.3 mm, P = 0.028), pin-joint ratio (7.439%, P = 0.006) and pin-physis ratio (8.244%, P = 0.001). The probability of revision operations due to ongoing growth was higher in this group (risk ratio: 6.57, P = 0.0008). Time to physeal closure was not significantly different, but growth velocity was significantly higher in the un-threaded group. The lower probability of cam deformity was not significant. Functional and clinical results were not significantly different at average 11.2 years' follow-up. Un-threaded screws allow for significantly more growth than standard threaded screws. The un-threaded screw could not be recommended due to the higher re-operation rates, without any proven benefit.
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Affiliation(s)
- Henry Mills
- Department of Orthopaedic, Sheffield Children's Hospital NHS Trust, Sheffield
| | - Mark J Flowers
- Department of Orthopaedic, Sheffield Children's Hospital NHS Trust, Sheffield
| | | | - Nicolas Nicolaou
- Department of Orthopaedic, Sheffield Children's Hospital NHS Trust, Sheffield
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23
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Harrison WD, Chan YC, James LA, Nayagam S. The association of socioeconomic deprivation and paediatric open tibia fractures. J Pediatr Orthop B 2021; 30:423-430. [PMID: 32991371 DOI: 10.1097/bpb.0000000000000808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The primary aim of this study is to test the association of open tibial fractures (OTF), in a paediatric age group, with socioeconomic deprivation. The secondary objectives are to more clearly define the epidemiological characteristics of these high-energy injuries. A consecutive series of patients with OTF presenting to a major trauma centre at a children's hospital in Liverpool had age, gender, fracture pattern, mechanism, timing of the injury and their postcode of residence recorded. Those cases outside Liverpool, Sefton and Knowsley local authorities were excluded from incidence calculations. Postcodes were used to generate deprivation scores (Index of Multiple Deprivation, 2010) based on census data (2011). Cases were ranked and allocated to deprivation quintiles. A comparison to the normal population within Merseyside was undertaken using regression analysis. There were 71 cases over a 9-year period. Fifty cases resided within the geographical limits of Merseyside and were included in the incidence calculations. The annual incidence of paediatric OTF is 3.09 per 100 000 children (0-16 years). The median age at injury was 11 years (range 2-16) and this occurred most usually during term-time between 3 and 5 p.m. from road traffic collisions. Paediatric OTFs are strongly associated with socioeconomic deprivation. The association with deprivation reflects an exposure to unsafe roads in busy urban areas with limited access to safe playing spaces. Socioeconomically deprived men are most at risk from this injury. The links between deprivation and outcomes of treatment or long-term prospects are unclear.
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Affiliation(s)
- William D Harrison
- Department of Trauma and Orthopaedics, North-West Deanery (Mersey sector)
| | - Yuen C Chan
- Department of Trauma and Orthopaedics, North-West Deanery (Mersey sector)
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24
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Wirries N, Heinrich G, Derksen A, Schwarze M, Budde S, Windhagen H, Floerkemeier T. Which anatomical conditions are associated with limitations of the hip function after SCFE? J Orthop 2021; 26:94-97. [PMID: 34341629 DOI: 10.1016/j.jor.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
Background Patients sustained a slipped capital femoral epiphysis (SCFE) might have symptoms beyond their stabilization surgery in the childhood. Methods 35 patients with a SCFE were treated in our clinic and available for a clinical follow-up. The results were compared in dependence of the presence of dysplasia, acetabular retroversion or a FAI type CAM. Results A FAI type CAM led to significant inferior results (p < 0.05), especially in combination with a retroversion. Conclusions The clinical outcome seemed to be influenced by the presence of a FAI type CAM or a combination with a retroversion, which might aggravate the femoro-acetabular conflict. Level of evidence III, retrospective.
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Affiliation(s)
- Nils Wirries
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Gesche Heinrich
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Alexander Derksen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Stefan Budde
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
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25
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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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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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Perry DC, Arch B, Appelbe D, Francis P, Spowart C, Knight M. A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis. Bone Jt Open 2020; 1:35-40. [PMID: 33215105 PMCID: PMC7659633 DOI: 10.1302/2633-1462.13.bjo-2020-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.
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Affiliation(s)
- Daniel C Perry
- University of Liverpool, Institute of Translational Medicine, Alder Hey Hospital, Liverpool, UK
| | - Barbara Arch
- University of Liverpool, Institute of Translational Medicine, Alder Hey Hospital, Liverpool, UK
| | - Duncan Appelbe
- NDORMS, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Priya Francis
- University of Liverpool, Institute of Translational Medicine, Alder Hey Hospital, Liverpool, UK
| | - Catherine Spowart
- University of Liverpool, Institute of Translational Medicine, Alder Hey Hospital, Liverpool, UK
| | - Marian Knight
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Abstract
This chapter describes the musculoskeletal (MSK) context in children and young people as an important contributor to the global non-communicable disease burden. Through selected MSK conditions, we describe the impact on patients, families and communities and highlight the challenges that need to be addressed. We focus on opportunities for better working together and describe exemplar initiatives to raise awareness, workforce capacity building, models of care and research agendas to have a greater global context.
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Hailer YD. Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls. Acta Orthop 2020; 91:457-463. [PMID: 32285743 PMCID: PMC8023925 DOI: 10.1080/17453674.2020.1749810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE.Patients and methods - 2,564 patients diagnosed with SCFE at age 5-16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals.Results - The risk of obesity (HR 9, 95% CI 7-11) and hypothyroidism (HR 3, CI 2-4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1-1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1-2). The incidence of SCFE did not increase over the past decades.Interpretation - Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates.
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Affiliation(s)
- Yasmin D Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Sweden,Correspondence:
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Monte FA, Melo PS, Alves A, Oliveira Junior JV, Alencar G, Soares FC. Evaluation of the Southwick Angle in Two Hundred Hips of Asymptomatic Children and Adolescents. Rev Bras Ortop 2020; 55:360-366. [PMID: 32616983 PMCID: PMC7316541 DOI: 10.1055/s-0040-1701289] [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: 10/11/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
Abstract
Objectives To measure the mean value of the Southwick angle using two different methods, the manual (1) and digital (2) methods, and to establish a normality value. Methods A primarily descriptive study with 100 children and adolescents. Individuals with orthopedic complaints regarding the hips and/or knees or gait alterations were excluded. For each patient, an X-ray was performed on the lateral incidence of Lowenstein, totaling 100 radiographs and 200 hips. The Southwick angle was measured in two different ways by the same researcher: the conventional method (1), tracing the lines with pencils and measuring the angle with the use of a goniometer and negatoscope, and through the GNU Image Manipulation Program (GIMP) image editor (open source), version 2.7.0 (2), in which the lines were plotted and the angles of both hips were gauged on each radiograph. Later, we sought to evaluate the correlation between the two methods and to verify the mean Southwick angle by categorically correlating it by gender, age group and body mass index (BMI) in asymptomatic children and adolescents. All radiographs were authorized by the children and adolescents' parents/legal guardians. The study was approved by the ethics committee of the institutions in which the research was conducted. Results The mean of the Southwick angles obtained by the conventional method was of 8.7° (±2.0°), and, by the digital method, it was of 9.9° (±1.8°). The angle obtained by the two methods was statistically significant ( p < 0.001). The majority of the studied population (95%) had a body mass index (BMI) > 18.5, and the mean of the angles was within the previously established value (∼ 10°). Conclusion For the first time, using a substantial sample size, a normal value for the Southwick angle measured in asymptomatic individuals was demonstrated. In addition, the image editor proved to be a reliable method to measuring the Southwick angle.
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Affiliation(s)
- Felipe Alves Monte
- Departamento de Ortopedia e Traumatologia, Hospital da Restauração Governador Paulo Guerra, Recife, PE, Brasil
| | - Paulo Sergio Melo
- Departamento de Ortopedia e Traumatologia, Instituto Materno Infantil de Pernambuco, Recife, PE, Brasil
| | - Amaro Alves
- Departamento de Ortopedia e Traumatologia, Hospital da Restauração Governador Paulo Guerra, Recife, PE, Brasil
| | | | - George Alencar
- Departamento de Ortopedia e Traumatologia, Instituto Materno Infantil de Pernambuco, Recife, PE, Brasil
| | - Fabio Couto Soares
- Departamento de Ortopedia e Traumatologia, Instituto Materno Infantil de Pernambuco, Recife, PE, Brasil
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Effect of seasonal variation on the peak presentation of slipped capital femoral epiphysis. A comparison of children in Johannesburg, South Africa and London, UK. J Pediatr Orthop B 2020; 29:268-274. [PMID: 31688335 DOI: 10.1097/bpb.0000000000000689] [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: 11/25/2022]
Abstract
Variation exists in the peak presentation of slipped capital femoral epiphysis (SCFE). The objective of this study was to compare two cohorts of children (South Africa and the UK) and explore similarities and differences regarding demographic and epidemiological features, incidence and seasonal variation in peak presentation. Patients presenting with SCFE at one of two hospitals were included in the study. A retrospective cohort was collected from hospital records. The following factors were recorded: duration of symptoms, chronicity, stability, seasonality, severity and prophylactic pinning. A total of 137 patients were included in the study - 70 patients (80 hips) from South Africa and 67 patients (73 hips) from the UK. Both sites recorded more than 50% incidence of a chronic slip. There was higher delay to presentation in the UK compared with South Africa (90 vs 60 days, P = 0.0262). The UK population were more skeletally mature (32.8% open triradiate cartilage) compared with the South Africa population (64.9% open triradiate cartilage). In both populations, the most common season of symptom onset was summer. In the UK, the most common season of symptom presentation was in autumn compared with summer in South Africa. This study found significant differences in the two countries, including a more skeletally mature population in the UK. Both cohorts showed seasonal variation in peak incidence, but there was more seasonal variation in peak incidence in the UK - in the summer for onset of symptoms and autumn months for time of presentation.
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32
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Swarup I, Shah R, Gohel S, Baldwin K, Sankar WN. Predicting subsequent contralateral slipped capital femoral epiphysis: an evidence-based approach. J Child Orthop 2020; 14:91-97. [PMID: 32351620 PMCID: PMC7184641 DOI: 10.1302/1863-2548.14.200012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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 The purpose of this study was to identify risk factors for developing a subsequent contralateral slipped capital femoral epiphysis (SCFE) and provide a prediction score to quantify risk of subsequent slip at the time of initial presentation. METHODS This retrospective study included patients that presented with a unilateral SCFE between 2006 and 2017. Chart and radiographic review were performed to collect demographic, clinical and radiographic risk factors. Descriptive statistics, univariate analyses and multivariate regression analysis were used to compare risk factors between patients that did or did not develop a subsequent contralateral SCFE. RESULTS This study included 183 patients and 33 patients (18%) developed a subsequent contralateral SCFE. Younger age at time of initial presentation, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between both sides during index presentation were significant predictors of subsequent contralateral SCFE. Specifically, age ≤ 11 years, modified Oxford Score ≤ 20 and difference in epiphyseal-diaphyseal angle of ≤ 21° between both hips were predictive of a contralateral slip (Area Under the Curve = 0.78; p < 0.05). The presence of each risk factor increased the risk of subsequent contralateral SCFE and having all three risk factors increased the risk to 73%. CONCLUSION There is a significant risk of subsequent contralateral SCFE in patients with unilateral SCFE, and predictive risk factors include younger age, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between the affected and unaffected hips. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ishaan Swarup
- Division of Pediatric Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA,Correspondence should be sent to Ishaan Swarup, University of California San Francisco, UCSF Benioff Children’s Hospital Oakland, 747 52nd Street, Oakland, CA 94609, USA. E-mail:
| | - Ronit Shah
- Division of Pediatric Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shivani Gohel
- Division of Pediatric Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Keith Baldwin
- Division of Pediatric Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Wudbhav N. Sankar
- Division of Pediatric Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Obana KK, Siddiqui AA, Broom AM, Barrett K, Andras LM, Millis MB, Goldstein RY. Slipped Capital Femoral Epiphysis in Children without Obesity. J Pediatr 2020; 218:192-197.e1. [PMID: 31955882 DOI: 10.1016/j.jpeds.2019.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate rates and characteristics of slipped capital femoral epiphysis (SCFE) in children who are not obese to prevent missed diagnoses and subsequent complications. STUDY DESIGN A multicenter, retrospective review identified all patients with SCFE from January 1, 2003 to December 31, 2012. Patients were excluded if they received previous surgery at an outside institution, had no recorded height and weight, or had medical co-morbidity associated with increased risk of SCFE. Body mass index (BMI) percentile for age was calculated and categorized for each patient (patients without obesity vs with obesity). RESULTS In total, 275 patients met inclusion criteria. Average BMI was 91.2 percentile (range: 8.4-99.7). Thirteen percent (34 patients) were considered "normal weight" (BMI 5%-85%), 17% (48 patients) were considered "overweight" (BMI 85%- 95%), and 70% (193 patients) were considered "obese" (BMI >95%). Average BMI percentile was higher in male than female patients (93.2 ± 12.7 vs 88.5 ± 21.4, P = .034). Patients without obesity were older compared with patients with obesity (12.2 ± 1.7 vs 11.7 ± 1.6 years, P = .015). Fewer patients without obesity were seen at the hospital in the southwest. The southwest had fewer patients without obesity than the northeast (18.3% vs 36.1%, P = .002). Patients without obesity were more likely to present with a severe slip as graded by Wilson percent displacement (27.2% vs 11.4%, P = .007) and an unstable slip (32.9% vs 14.7%, P = .001). CONCLUSION Rates of nonobese SCFE in this study are higher than reported in the previous literature. Normal weight patients with SCFE are more likely to be older, female, and present with a severe and unstable SCFE.
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Affiliation(s)
- Kyle K Obana
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ali A Siddiqui
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Alexander M Broom
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kody Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Rachel Y Goldstein
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
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Kondiboyina V, Raine LB, Kramer AF, Khan NA, Hillman CH, Shefelbine SJ. Skeletal Effects of Nine Months of Physical Activity in Obese and Healthy Weight Children. Med Sci Sports Exerc 2020; 52:434-440. [PMID: 31479005 PMCID: PMC6962537 DOI: 10.1249/mss.0000000000002148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Obesity during adolescence has multisystem health consequences. The objective of this work was to determine whether preadolescent overweight/obese children's bones respond to a 9-month physical activity intervention by increasing bone density similar to healthy weight children. METHODS Participants included overweight/obese (BMI > 85%) and healthy weight (15% < BMI < 85%) preadolescents (8-9 yr old). Participants in the physical activity group participated in a 9-month physical activity curriculum every day after school. The wait list control group received no intervention. Both groups had overweight/obese children and healthy weight controls. Whole-body bone mineral content, area, and bone mineral apparent density (BMAD) were assessed using dual x-ray absorptiometry) at the beginning and end of the 9-month trial in the physical activity and control group. RESULTS Overweight/obese preadolescent children had higher BMAD than healthy weight children (P < 0.001 for spine, leg, and whole body). However, the density/weight (BMAD/lean mass) was lower in overweight/obese children than that in healthy weight children, indicating that the density of bones in overweight/obese children may not compensate sufficiently for the excessive load due to weight. The change in BMAD over 9 months was greater in healthy weight children than overweight/obese children in the whole body and leg, but not the lumbar spine. Physical activity caused a site-specific increase in bone density, affecting the legs more than the lumbar spine, but there was no significant difference in the effect of exercise between the healthy weight and the overweight/obese group. CONCLUSIONS The smaller change in BMAD over the 9 months and lower BMAD per unit lean mass in overweight/obese compared with healthy weight children may indicate a slower rate of bone mass accrual, which may have implications for bone health during skeletal growth in obese/overweight children.
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Affiliation(s)
| | - Lauren B Raine
- Department of Psychology, Northeastern University, Boston, MA
| | | | - Naiman A Khan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
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Oetgen ME, Litrenta J, Koutenaei BA, Cleary KR. A novel surgical navigation technology for placement of implants in slipped capital femoral epiphysis. Int J Med Robot 2019; 16:e2070. [PMID: 31875353 DOI: 10.1002/rcs.2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 11/06/2019] [Accepted: 12/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fixation with a single screw is the recommended treatment for slipped capital femoral epiphysis (SCFE). Achieving optimal implant positioning can be difficult owing to the complex geometry of the proximal femur in SCFE. We assessed a novel navigation technology incorporating an inertial measurement unit to facilitate implant placement in an SCFE model. METHODS Guidewires were placed into 30 SCFE models, using a navigation system that displayed the surgeon's projected implant trajectory simultaneously in multiple planes. The accuracy and the precision of the system were assessed as was the time to perform the procedure. RESULTS Implants were placed an average of 5.3 mm from the femoral head center, with a system precision of 0.94 mm. The actual trajectory of the implant deviated from the planned trajectory by an average of 4.9° ± 2.2°. The total average procedure time was 97 seconds. CONCLUSION The use of computer-based navigation in a SCFE model demonstrated good accuracy and precision in terms of both implant trajectory and placement in the center of the femoral head.
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Affiliation(s)
- Matthew E Oetgen
- Division of Orthopaedic Surgery and Sports Medicine, Children's National Health System, Washington, DC
| | - Jody Litrenta
- Division of Pediatric Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Bamshad Azizi Koutenaei
- Division of Computer Aided Medical Procedures (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Kevin R Cleary
- Sheik Zayed Institute for Surgical Intervention, Children's National Health System, Washington, DC
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Livingstone JP, Opanova MI, Durkin RC, Burkhalter W. Management of Slipped Capital Femoral Epiphysis: The Hawai'i Experience. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:21-25. [PMID: 31773107 PMCID: PMC6874696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Slipped capital femoral epiphysis (SCFE) is a growing problem amongst children in Hawai'i as well as throughout the world. With increasing rates of childhood obesity, SCFEs are affecting more patients at younger ages. This makes the treatment of SCFEs critical as many children with SCFEs have significant growth remaining. There are a host of treatment options based on different classification schemes which can make it difficult to determine the appropriate care for a SCFE patient. In our practice, patients are treated based on a combination of angular displacement, stability as defined by Loder, and patient age. The procedures vary from single screw in-situ fixation for a mild deformity to a modified Dunn procedure for a high-grade deformity in the skeletally immature patient. For all our open fixation methods, epiphyseal perfusion is monitored with an 18-gauge needle attached to an arterial monitor and we routinely remove fixation after physeal closure. Excellent outcomes have been noted for the modified Dunn in our practice. This article describes the algorithm used to treat SCFE in Hawai'i at a tertiary children's medical center.
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Affiliation(s)
- John P. Livingstone
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JPL, MIO)
| | - Mariya I. Opanova
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JPL, MIO)
| | - Robert C. Durkin
- Department of Orthopedics, Kapi‘olani Medical Center for Women and Children, Honolulu, HI (RCD, WEB)
| | - William Burkhalter
- Department of Orthopedics, Kapi‘olani Medical Center for Women and Children, Honolulu, HI (RCD, WEB)
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Tucker A, Ballard J, Cosgrove A. Temporal changes in slipped upper femoral epiphysis at a regional level: a declining incidence and literature review. J Child Orthop 2019; 13:445-456. [PMID: 31695811 PMCID: PMC6808072 DOI: 10.1302/1863-2548.13.190037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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 Slipped upper femoral epiphysis (SUFE) is one of the most common adolescent hip pathologies in children with potential for life-long morbidity secondary to avascular necrosis (AVN). The primary aim is to determine an up-to-date demographic of SUFE, as well as current trends in presentation and radiological characteristics. Secondary aims are to quantify prophylactic fixation and subsequent contralateral SUFE. METHODS Between 01 January 2013 and 31 December 2015, all cases of SUFE were identified in Northern Ireland. Patient demographics, slip characteristics and outcomes are presented and the incidence rates were calculated using census data. Temporal changes in incidence, compared with a previous cohort, are demonstrated. RESULTS A total of 56 patients (80 hips) were identified. Based on census data, SUFE incidence has declined from 7.14 to 4.69/100,000 population aged < 16 years. Male cases predominated by > 2:1 ratio, and tended to be older than female cases. Approximately 75% of patients were above the 75th centile for age-sex adjusted body weight. Knee pain as a presenting symptom led to a delay in diagnosis. Prophylactic fixation was performed in 25.9%, with contralateral slips occurring in 27.5%. AVN occurred in 7.4% and remained static. CONCLUSION The incidence of SUFE has declined ~34% in our region. When SUFE occurs, knee pain often results in a delay in definitive diagnosis, and commands clinical vigilance to avoid delays in diagnosis. Patients in our region should be aware of a 1-in-4 contralateral slip rate. Overall, AVN rates remain static and are acceptable, despite the declining incidence of SUFE. LEVEL OF EVIDENCE Level III - Retrospective Cohort Study.
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Affiliation(s)
- A. Tucker
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland,Correspondence should be sent to: A. Tucker, C/O Fracture Clinic, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, BT12 6BE, Northern Ireland. E-mail:
| | - J. Ballard
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - A. Cosgrove
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
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Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is the most significant hip disease in adolescence. Because of its typical occurrence at the time of the pubertal growth spurt and some particular clinical symptoms, it has been a topic of special interest in orthopedic research for a long time. A large number of etiological factors have been described, however their meaning in detail is still controversial. OBJECTIVES After a short summary of the structure and function of the epiphysis, an overview of concepts in the pathogenesis of SCFE is given. MATERIALS AND METHODS A selective review of literature was performed. RESULTS Etiology of SCFE includes genetic, endocrinologic, histochemical and biomechanical factors. During puberty, obesity together with reduced femoral antetorsion are the main risk factors for the disease. The rarer atypical SCFE is closely related to metabolic disorders or other chronical diseases. The pathogenesis is characterized by the disproportion between the load-bearing capacity of the epiphysis and the acting forces on the proximal femur. CONCLUSIONS The concept of the multifactorial etiology of SCFE is convincing. The susceptibility of the femoral epiphysis is explained considering the remarkable biomechanic local forces. The initial damage can be shown on the histological and the histochemical level. Important new aspects refer to the leptin-metabolism. However, in the majority of cases, biomechanical factors seem to be more significant than endocrinological phenomena. A complete understanding has not succeeded to date.
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Affiliation(s)
- H J Hellmich
- Kinderorthopädie, Universitätskinderspital beider Basel (UKBB), Spitalstrasse 33, 4056, Basel, Schweiz.
| | - A H Krieg
- Kinderorthopädie, Universitätskinderspital beider Basel (UKBB), Spitalstrasse 33, 4056, Basel, Schweiz
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Wirth T, Eberhardt O, Cerkez D, Fernandez F. [Specific cases of slipped capital femoral epiphysis : Endocrinopathies, hormone therapy and other rare causes]. DER ORTHOPADE 2019; 48:685-692. [PMID: 30997550 DOI: 10.1007/s00132-019-03728-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In slipped capital femoral epiphysis (SCFE) atypical causes can be found in about 5% of cases. The patients' age differs from the typical age of SCFE patients of between age 10 and 16. There are numerous causes of atypical SCFE: different endocrine disorders, sequelae of chronic renal failure and effects of radiation and chemotherapy on the proximal femoral physis. The diagnostic and therapeutic procedures must be expanded to the search for and treatment of endocrinological disorders. Orthopaedic treatment follows the principles applied to patients with idiopathic SCFE. However, the specific treatment modalities which arise from different patient ages and bone qualities are taken into account.
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Affiliation(s)
- T Wirth
- Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland.
| | - O Eberhardt
- Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland
| | - D Cerkez
- Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland
| | - F Fernandez
- Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland
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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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Mbonda A, Tchuenkam LW, Tochie JN, Abogo S, Essomba R. Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review. Open Orthop J 2019. [DOI: 10.2174/1874325001913010152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Slipped Capital Femoral Epiphysis (SCFE) is an incapacitating orthopedic disease, particularly affecting older children and adolescents and caused by the sliding of the proximal femoral epiphysis on the metaphysis. SCFE has a clinical polymorphism, compounded with a certain diagnostic variability among health practitioners and the relatively high cost of its surgical management contribute to the diagnostic delay observed in most developed countries as well as developing ones. Herein, we report the case of SCFE in an adolescent Cameroonian, with emphasis on its diagnostic and therapeutic challenges in Low and Middle-Income Countries (LMICs), in a bit to improve on timely recognition and management by clinicians in these settings.
Case Presentation:
A 10-year-old girl has presented with unilateral right thigh pain of more than one year duration associated with a limping gait and no fever. Before the referral to our health facility, she consulted several general practitioners in rural areas and pediatricians in the city with no definite diagnosis. On the basis of the clinical and the imaging studies, the diagnosis of stable right SCFE with moderate displacement was made. Under general anesthesia, the patient underwent open reduction and internal fixation with three pins under c-arm fluoroscopy. Clinical and radiological follow-up till one year after surgical intervention were satisfactory. The pins were removed after one year of fixation confirming a good bone fusion in plain x-ray. Her clinical examination and radiological follow-up three years after removal of the pins were satisfactory.
Conclusion:
The case report illustrates that SCFE often a missed diagnosis in LMICs. This is worrisome because delayed diagnosis may lead to long-term complications such as avascular necrosis and early degenerative joint disease. Although the above case was missed by several clinicians and finally diagnose late, the present case highlights the need for a high index of clinical suspicion in order to timely diagnose and timely manage SCFE to avert potential long-term physical disabilities and psychological trauma in children.
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Perry DC, Metcalfe D, Lane S, Turner S. Childhood Obesity and Slipped Capital Femoral Epiphysis. Pediatrics 2018; 142:peds.2018-1067. [PMID: 30348751 DOI: 10.1542/peds.2018-1067] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5828355774001PEDS-VA_2018-1067Video Abstract BACKGROUND: Slipped capital femoral epiphysis (SCFE) is believed to be associated with childhood obesity, although the strength of the association is unknown. METHODS We performed a cohort study using routine data from health screening examinations at primary school entry (5-6 years old) in Scotland, linked to a nationwide hospital admissions database. A subgroup had a further screening examination at primary school exit (11-12 years old). RESULTS BMI was available for 597 017 children at 5 to 6 years old in school and 39 468 at 11 to 12 years old. There were 4.26 million child-years at risk for SCFE. Among children with obesity at 5 to 6 years old, 75% remained obese at 11 to 12 years old. There was a strong biological gradient between childhood BMI at 5 to 6 years old and SCFE, with the risk of disease increasing by a factor of 1.7 (95% confidence interval [CI] 1.5-1.9) for each integer increase in BMI z score. The risk of SCFE was almost negligible among children with the lowest BMI. Those with severe obesity at 5 to 6 years old had 5.9 times greater risk of SCFE (95% CI 3.9-9.0) compared with those with a normal BMI; those with severe obesity at 11 to 12 years had 17.0 times the risk of SCFE (95% CI 5.9-49.0). CONCLUSIONS High childhood BMI is strongly associated with SCFE. The magnitude of the association, temporal relationship, and dose response added to the plausible mechanism offer the strongest evidence available to support a causal association.
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Affiliation(s)
- Daniel C Perry
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; .,Alder Hey Children's Hospital, Liverpool, United Kingdom.,Oxford Trauma, Nuffield Department of Orthopaedics Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; and
| | - David Metcalfe
- Oxford Trauma, Nuffield Department of Orthopaedics Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; and
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Steven Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Abstract
BACKGROUND Developmental dysplasia of the hip (DDH), which encompasses a wide spectrum of disease from mild dysplasia to frank dislocation, is one of the most common developmental deformities of the lower extremities and one of the leading causes of future osteoarthritis and hip arthroplasty. Legg-Calvé-Perthes disease (LCPD) results from a vascular insult to the growing femoral epiphysis, which in turn can create permanent morphologic changes to the hip joint. Slipped capital femoral epiphysis (SCFE) occurs when the proximal femoral physis fails allowing the epiphysis to displace in relation to the metaphysis. Infections about the hip also create significant morbidity in the pediatric hip. METHODS We searched the PubMed database for all studies related to DDH, LCPD, SCFE, and pediatric hip infections that were published between July 1, 2014 and August 31, 2017. The search was limited to English articles and yielded 839 papers. This project was initiated by the Pediatric Orthopaedic Society of North America Publications Committee and was reviewed and approved by the Pediatric Orthopaedic Society of North America Presidential Line. RESULTS A total of 40 papers were selected for review based upon new and significant findings. Select historical manuscripts are also included to provide sufficient background information. CONCLUSIONS DDH, LCPD, SCFE, and infections about the hip continue to be important topics in pediatric orthopaedics and areas of vital research. This manuscript reviews the most important recent literature on the diagnosis and treatment of these pediatric hip conditions. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Matthew R Schmitz
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, TX
| | - Todd J Blumberg
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA
| | - Susan E Nelson
- Department of Orthopaedics and Rehabilitation, University of Rochester and the Golisano Children's Hospital at Strong, Rochester, NY
| | - Julieanne P Sees
- Department of Orthopaedic Surgery, Nemours Alfred I Dupont Hospital for Children, Wilmington, DE
| | - Wudbhav N Sankar
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, Inge T, Linden BC, Mattar SG, Michalsky M, Podkameni D, Reichard KW, Stanford FC, Zeller MH, Zitsman J. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis 2018; 14:882-901. [PMID: 30077361 PMCID: PMC6097871 DOI: 10.1016/j.soard.2018.03.019] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022]
Abstract
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
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Affiliation(s)
- Janey S A Pratt
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California.
| | - Allen Browne
- Diplomate American Board of Obesity Medicine Falmouth, Maine
| | - Nancy T Browne
- WOW Pediatric Weight Management Clinic, EMMC, Orono, Maine
| | - Matias Bruzoni
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California
| | - Megan Cohen
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | | | - Thomas Inge
- University of Colorado, Denver and Children's Hospital of Colorado Aurora, Colorado
| | - Bradley C Linden
- Pediatric Surgical Associates and Allina Health Minneapolis, Minnesota
| | - Samer G Mattar
- Swedish Weight Loss Services Swedish Medical Center Seattle, Washington
| | - Marc Michalsky
- Nationwide Children's Hospital and The Ohio State University Columbus, Ohio
| | - David Podkameni
- Banner Gateway Medical Center and University of Arizona Phoenix, Arizona
| | - Kirk W Reichard
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | - Fatima Cody Stanford
- Diplomate American Board of Obesity Medicine Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | - Jeffrey Zitsman
- Morgan Stanley Children's Hospital of NY Presbyterian and Columbia University Medical Center New York, New York
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Perry DC, Wright JG, Cooke S, Roposch A, Gaston MS, Nicolaou N, Theologis T. A consensus exercise identifying priorities for research into clinical effectiveness among children's orthopaedic surgeons in the United Kingdom. Bone Joint J 2018; 100-B:680-684. [PMID: 29701090 DOI: 10.1302/0301-620x.100b5.bjj-2018-0051] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims High-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. Methods A modified Delphi technique was used, which involved an initial scoping survey, a two-round Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. Results A total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). Conclusion This consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials. Cite this article: Bone Joint J 2018;100-B:680-4.
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Affiliation(s)
- D C Perry
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK and University of Oxford, Oxford, UK
| | - J G Wright
- University of Oxford, Botnar Research Centre, Oxford, UK
| | - S Cooke
- University Hospital Coventry and Warwick, Coventry, UK
| | - A Roposch
- UCL GOS Institute of Child Health, University College London, London, UK
| | - M S Gaston
- Royal Hospital for Sick Children, Edinburgh, UK
| | - N Nicolaou
- Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - T Theologis
- University of Oxford, Botnar Research Centre, Oxford, UK
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