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The Journal of Bone and Joint Surgery, Vol 74, Issue 6 799-809, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Fixation with a single screw for slipped capital femoral epiphysis
WT Ward, J Stefko, KB Wood and CL Stanitski
Children's Hospital of Pittsburgh, Pennsylvania 15213.
The effectiveness of a single 6.5 or seven-millimeter-diameter screw for
the promotion of premature physeal closure and the provision of stability
of a slipped capital femoral epiphysis was investigated. Physeal fusion was
demonstrated in forty-nine (92 per cent) of fifty-three hips after fixation
with a single screw. Premature fusion of the involved physis, compared with
the uninvolved, contralateral physis, was documented (p less than 0.001).
Epiphyseal stability, as measured by the lateral head-shaft angle, was
maintained in all except one hip. An analysis of twenty-nine hips for which
there was a complete set of radiographs, that were in patients who had no
endocrine problems, and that were the first hips entered into the study
when the patient had bilateral involvement, revealed an average time to
closure of the physeal line of thirteen months. A longer time to physeal
fusion was correlated with increasingly eccentric placement of the screw (r
= 0.44, p = 0.016) and increasing severity of the slip (r = -0.536, p =
0.003). There was no correlation between the age at the time of the
operation, race, or sex and the time to physeal fusion. Only one patient
had penetration by a screw, and no chondrolysis, avascular necrosis, or
other serious problems developed. Fixation with a single 6.5 or
seven-millimeter-diameter screw provided adequate epiphyseal stability and
promoted premature physeal fusion in our patients, while decreasing the
rate of complications compared with that reported to be associated with
fixation with multiple screws or pins.
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