Cases reported "Epiphyses, Slipped"

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11/21. Multiple fractures in early infancy: report of two unusual cases.

    Two cases of multiple fractures, one in a newborn with an unclassified bone dysplasia, another in an infant with recurrent fits of unknown etiology are reported. The second case is the youngest in the literature with bilateral slipped capital femoral epiphyses and bilateral femoral neck fractures, secondary to stress injury.
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12/21. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis.

    This is a report on a University of illinois Hospital series of cases of extracapsular base of the neck osteotomy for slipped capital femoral epiphyses. The osteotomy was performed on 20 hips in 16 patients, with a 71/2 year average follow-up. The results of this procedure are encouraging and illustrate the advantages of technical simplicity and minimal risk of avascular necrosis. The method does not create any additional deformity. The only disadvantage is that the correction could be limited. The maximum correction of posterior tilt was 55 degrees and the maximum correction of varus deformity was 50 degrees.
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13/21. Abduction contracture: an unusual complication in the treatment of acute capital femoral epiphysiolysis.

    A significant abduction contracture of the hip followed closed reduction and pinning of an acute slip of the proximal femoral epiphysis in a 13-year-old boy. The contracture was corrected by removal of this bony prominence. Over-reduction of the slipped epiphysis into valgus is thought to have stimulated bony overgrowth at the posteromedial aspect of the capital femoral epiphyseal-neck junction. This causes a block to adduction by abutting against the inferior lip of the acetabulum. To our knowledge, this complication has not been previously reported.
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14/21. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. A follow-up note.

    The long-term clinical and roentgenographic results of cuneiform osteotomy of the femoral neck at the level of the physis in sixty-one patients (sixty-six hips) who had a slipped capital femoral epiphysis of more than 30 degrees were reviewed. The result was excellent in fifty-five hips, good in six hips, fair in two hips, and poor in three hips. The results in thirty-eight of these hips were reported in 1984. Osteoarthrosis developed in six patients; it was mild in four patients, moderate in one, and severe in one. Two patients had evidence of chondrolysis. The pin was found to have penetrated into the joint in all six of the patients who had osteoarthrosis and in one patient who had chondrolysis. Complete avascular necrosis of the femoral head developed in two patients and segmental avascular necrosis in one; all three patients had an acute-on-chronic slip.
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15/21. Remodeling of the femoral neck after in situ pinning for slipped capital femoral epiphysis.

    During a period of thirty-six years, sixty-two patients with seventy slipped capital femoral epiphyses were treated by pinning in situ. Twelve of these patients, ten years and eight months to sixteen years and one month old, were treated for moderate to severe slipping by pinning in situ. After follow-ups ranging from two to seventeen years, all but two patients had satisfactory remodeling of the femoral head and neck and were asymptomatic. The two with incomplete or no remodeling had no symptoms. It was concluded that the effects of remodeling have been largely ignored and that pinning in situ when possible, followed if necessary by osteoplasty or osteotomy through the lesser trochanter, is a safe and effective treatment.
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16/21. Bone endoscopy: direct visual confirmation of cannulated screw placement in slipped capital femoral epiphysis.

    Intraosseous endoscopic examination of the femoral neck and head was performed during the course of percutaneous screw fixation in 12 patients with slipped capital femoral epiphysis (SCFE). Visualization was satisfactory in 13 hips of these patients. We were able to distinguish trabecular bone and physeal cartilage endoscopically. Evidence of articular penetration was documented endoscopically in two patients. One patient had been referred for persistent hip pain and chondrolysis 6 months after screw insertion. Chronic joint penetration was observed endoscopically at the time of revision operation. In the second patient, transient pin penetration was visualized during cannulated screw fixation of a severe slip.
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17/21. Open bone peg epiphysiodesis for slipped capital femoral epiphysis.

    The records of 43 patients who underwent 64 open bone peg epiphysiodeses for slipped capital femoral epiphysis were retrospectively reviewed. There were 18 unstable and 46 stable slips. The average duration of follow-up was 35 months (range, 12-100). Healing occurred in all cases at an average of 17 weeks after surgery. At the time of healing, 27 hips (42%) showed a change in the degree of slip. At the most recent visit, the head-shaft angle had improved in 19 hips (30%), although the majority of hips showed resorption of the anterior neck prominence. The degree of remodeling showed no correlation with time to healing, duration of follow-up, or the status of the triradiate cartilage. The average operating time and blood loss per hip were 122 /- 34 min and 426 /- 238 ml, respectively. Complications included four hips with avascular necrosis and three with chondrolysis, three infections, four delayed wound healings, seven cases of transient anterolateral thigh hypesthesia, and 44 hips with hetertopic ossification. Because of the potential morbidity of this procedure, we no longer perform it as a primary operation for stable slipped capital femoral epiphysis.
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18/21. Differential diagnosis in physical therapy evaluation of thigh pain in an adolescent boy.

    Slipped capital femoral epiphysis (SCFE) is a condition of the adolescent hip in which the femoral head displaces relative to the femoral neck. This disorder is characterized by a synovitis of the hip joint or a mechanical limitation of motion with pain referred to the thigh or knee. The case described in this report is typical of an adolescent with SCFE. A brief review of epidemiology, etiology, clinical presentation, and treatment is presented to facilitate the physical therapist's knowledge of this condition and its proper management. Delay in diagnosis and treatment of SCFE may result in progression of the slip and chronic disability from osteoarthritis. It is imperative, therefore, that a patient suspected of having this condition be promptly referred to an orthopaedic surgeon for radiographic evaluation.
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19/21. Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.

    Two patients had displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis. Both fractures required closed reduction and internal fixation. Inadvertent derotation of the femur occurred in both patients and allowed fixation of the fracture through the intramedullary canal of the femoral neck without anterior penetration of the pins into the joint; a nonunion occurred in this patient. The other patient developed chondrolysis and avascular necrosis. Because the femoral neck is vulnerable to stress fractures in young adults, there is some question whether pins placed anteriorly through the femoral neck cortex should be removed.
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20/21. Slipped femoral capital epiphysis as a sequela to childhood irradiation for malignant tumors.

    Five cases of slipped femoral capital epiphysis were noted in children with prior irradiation for malignancy whose femoral head and neck had been included in the radiation portal. Three of the 5 were patients who had lymphoma. As a result of increasing survival rates for these types of patients, this previously unrecognized radiation-related growth disturbance may be more likely to be seen in the future.
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