Cases reported "Epiphyses, Slipped"

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1/15. Intertrochanteric osteotomy for the treatment of chronic slipped capital femoral epiphysis.

    Thirty six patients with a chronic slip of the capital femoral epiphysis and a femoral headneck angle of more than 30 degrees, as measured in a lateral radiograph, were treated by intertrochanteric osteotomy. The patients had an abnormal gait, an average age of 14.1 years and symptoms for an average of 14.5 months. The postoperative complications included two patients with avascular necrosis of the femoral head, four with coxa vara and two with loss of position requiring further operation. At an average of 7.5 years after operation 14 were good, 18 fair, and 4 poor on clinical assessment, with 13 good, 19 fair and 4 poor when judged by radiographs. patients with complications had only fair or poor results. A postoperative head-neck angle of less than 10 degrees indicated a good result.
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ranking = 1
keywords = operative
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2/15. Slipped capital femoral epiphysis in a child with sickle cell disease.

    Slipped capital femoral epiphysis in a child with sickle cell disease has not been reported previously. The diagnostic challenges, role of imaging techniques, and the medical treatment of this patient are discussed. The presentation of acute hip or leg pain in a child with sickle cell disease should alert the treating physician to the possibility of a vaso-occlusive crisis as the likely source of the child's pain. The goal of the current case report is to emphasize the need to maintain a high index of suspicion for other potential causes of hip, thigh, or knee pain such as slipped capital femoral epiphysis in an adolescent. Preoperative and postoperative care for a child with sickle cell disease needs to be modified to minimize the risks of vaso-occlusive complications.
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ranking = 1
keywords = operative
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3/15. Intra-operative arthrography facilitates accurate screw fixation of a slipped capital femoral epiphysis.

    We report the case of a 13-year-old obese child presenting with bilateral stable slipped capital femoral epiphyses, which were managed by percutaneous single screw fixation in situ under image intensifier control using arthrography.
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ranking = 2
keywords = operative
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4/15. Transient penetration of the hip joint during in situ cannulated-screw fixation of slipped capital femoral epiphysis.

    Before the routine intraoperative use of fluoroscopy at our institution during procedures to stabilize a slipped capital femoral epiphysis, twenty-five patients (thirty hips) had in situ cannulated-screw stabilization of a slipped capital femoral epiphysis with use of biplane radiography. Thus, a permanent record of the procedure was available for review. Fourteen hips in fourteen patients had an intraoperative episode during which the joint was penetrated by the guide-pin assembly or cannulated screw, or both. This penetration was corrected at the time of the operation. Eleven patients were followed for a minimum of two years (mean, thirty-nine months; range, twenty-four to sixty-three months). All physes went on to closure. None of the patients had clinical or radiographic evidence of chondrolysis. Transient penetration of the hip joint did not lead to chondrolysis in this series. This suggests that a single episode of penetration by a pin or screw, with immediate removal from the joint, is not associated with the development of chondrolysis.
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ranking = 1
keywords = operative
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5/15. Femoral neck fracture secondary to in situ pinning of slipped capital femoral epiphysis: a previously unreported complication.

    Two patients developed femoral neck fractures as a complication of in situ pinning for slipped capital femoral epiphysis (SCFE) by surgeons who each used a cannulated screw system. Both patients exhibited recurrent hip pain, femoral neck fracture, and coxa vara after asymptomatic postoperative intervals of 2 and 6 months, respectively. The fracture in one patient healed with weight relief alone: the other persisted, requiring a vascularized pedicle bone graft. Bone biopsy at surgery disclosed avascular necrosis (AVN). Based on preliminary studies of heat production during reaming, we speculate that these fractures developed through areas of AVN secondary to thermal injury.
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ranking = 0.5
keywords = operative
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6/15. Follow-up study of the subcapital wedge osteotomy for severe chronic slipped capital femoral epiphysis.

    Fifteen patients (18 hips) whose hips underwent subcapital wedge osteotomy for severe chronic slipped capital femoral epiphysis were studied. The results of 14 patients were excellent, and the patients themselves believed the results of the operation to be excellent. One patient had both avascular necrosis and cartilage necrosis. The postoperative follow-up period ranged from 2 to 17 years (average 10 years 3 months).
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ranking = 0.5
keywords = operative
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7/15. Thick lips, bumpy tongue, and slipped capital femoral epiphysis--a deadly combination.

    multiple endocrine neoplasia type 2b (MEN 2b) is a rare genetic disorder. Affected individuals have malignant thyroid tumors, pheochromocytoma, and ganglioneuromatosis. The musculoskeletal manifestations of MEN 2b include a Marfanoid habitus, pes cavus, scoliosis, slipped capital femoral epiphysis, joint laxity, poor muscle development, and delayed maturation. The initial clinical presentation of MEN 2b frequently involves the musculoskeletal system. The characteristics ganglioneuromatosis of the lips and tongue, however, should alert the orthopedic surgeon to the underlying disorder. Effective treatment of the malignant neoplasms hinges on early diagnosis. The risk of perioperative hypertensive crisis is significant; it may be prevented by appropriate treatment of the pheochromocytoma.
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ranking = 0.5
keywords = operative
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8/15. The treatment of epiphysiolysis of the hip. Further thoughts based on recent instructive cases.

    As an addendum to an earlier paper on the treatment of epiphysiolysis of the hip, the author presents four recent cases that demonstrate the importance both of early diagnosis and, more especially, of immediate operative treatment. This consists of reduction (if possible, as in the acute variety), epiphysiodesis and immediate mobilization. Otherwise, "late diagnosis", "inadequate treatment", or a combination of both condemns the hip joints of these young patients to permanent damage. Yet, by strict adherence to the programme of treatment suggested, it is possible to salvage the great majority of these hips.
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ranking = 0.5
keywords = operative
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9/15. Compression external fixation after biplane femoral trochanteric osteotomy for severe slipped capital femoral epiphysis.

    External compressive fixators were used for fixation after a femoral trochanteric osteotomy for severe slipped capital femoral epiphysis in two large teen-aged boys. The method was found to simplify both the operative fixation and the postoperative management. However, the healing time seemed to be prolonged.
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ranking = 1
keywords = operative
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10/15. Slipped capital femoral epiphysis with hypothyroidism treated by nonoperative method.

    patients receiving growth hormone or thyroid hormone are likely to develop a slipped capital femoral epiphysis during the period of spurt in growth. While pin fixation of these hips has been the popular method of treatment, it is possible to treat Grade I slips successfully by nonoperative methods provided that protection from weight-bearing is maintained until fusion of the epiphysis is complete.
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ranking = 2.5
keywords = operative
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