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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 97-100

Slipped capital femoral epiphysis following a delbet type 3 intertrochanteric fracture fixation


Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

Date of Submission04-Feb-2021
Date of Decision10-Apr-2021
Date of Acceptance08-Dec-2021
Date of Web Publication30-Sep-2022

Correspondence Address:
Dr. Alireza Moharrami
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atr.atr_11_21

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  Abstract 


Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting the adolescent population, usually between 10 and 15 years old, with some multifactorial etiologies may include obesity, trauma, and some endocrinal causes. We reported a 10-year-old boy who presented with unilateral SCFE following intertrochanteric fracture, which was fixed by dynamic compression plate 1 year before the SCFE. The SCFE fixed by a 6.5 mm cannulated screw. In the 1-year postoperative follow-up, the patient achieved the union and the physis did not displace. The patient had not any pain and his gait and function were normal in both sides.

Keywords: Delbet type 3, intertrochanteric fracture, slipped capital femoral epiphysis


How to cite this article:
Mirzashahi B, Moshirfar M, Moharrami A. Slipped capital femoral epiphysis following a delbet type 3 intertrochanteric fracture fixation. Arch Trauma Res 2022;11:97-100

How to cite this URL:
Mirzashahi B, Moshirfar M, Moharrami A. Slipped capital femoral epiphysis following a delbet type 3 intertrochanteric fracture fixation. Arch Trauma Res [serial online] 2022 [cited 2022 Nov 30];11:97-100. Available from: https://www.archtrauma.com/text.asp?2022/11/2/97/357558




  Introduction Top


Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting the adolescent population, usually between 10 and 15 years old, with some multifactorial etiologies may include obesity and trauma.[1] In some instances, endocrine pathologies comprising hypothyroidism, hypogonadism, and pan-hypopituitarism cause SCFE.[1] SCFE, after the union of previously fixed intertrochanteric (IT) fixation is a rare condition that poses essential issues (2). We presented a 10-year-old boy as a rare case of SCFE following IT fracture fixation.

Statement of informed consent

The patient was informed that data concerning the case would be submitted for publication, and he provided consent.


  Case Report Top


We describe a 10-year-old boy who presented with left side hip pain, limited range of motion, and occasional limping 1 year ago with a history of IT fracture (Delbet type 3) 2 years ago. The fracture was closely reduced and fixed by 6-hole 3.5 mm dynamic compression plate (DCP) with six screws and achieved an appropriate union in the fracture site [Figure 1] and [Figure 2].
Figure 1: The patient presented with left intertrochanteric fracture 1 year ago

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Figure 2: The fracture was fixed by 6-hole 3.5 mm dynamic compression plate

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The physical examination at presentation revealed limited and painful abduction and internal rotation of the left hip. The patient had a body mass index (BMI) of 25.8 kg/m2 (weight: 59 kg and height: 1.51 m). Initial X-ray examination showed a moderate SCFE (Southwick scale) with a 41° angle, as well as the presence of an opening of the left femoral head physis [Figure 3] and [Figure 4]. We evaluated the thyroid profile and Vitamin D level as common causes of SCFE, which showed the normal values, as seen in [Table 1].
Figure 3: The patient presented with left hip pain and limping, and slipped capital femoral epiphysis was diagnosed

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Figure 4: The X-ray shows decrease of neck shaft angle in the left side

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Table 1: Laboratory evaluation of thyroid profile and Vitamin D level

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The patient was treated with an in situ fixation technique by one 6.5 mm diameter cannulated screw after device removal by the femoral lateral approach incision on the left side. Furthermore, prophylactically the right side closely fixed by a 6.5 mm cannulated screw [Figure 5]. In the 1-year postoperative follow-up, the patient achieved the union and the physis did not displace [Figure 6]. The patient had not any pain and his gait and function were normal.
Figure 5: Bilateral hips were fixed by one 6.5 mm cannulated screw

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Figure 6: The last follow-up X-ray 1 year postoperative

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  Discussion Top


We reported a rare case of SCFE following IT fracture fixation. SCFE after treatment of proximal femoral fracture can be caused by inadequate treatment of the fracture. Orthopedic surgeons should be aware of this unusual complication, so that they can promptly recognize this complication and urgently treat it.[2]

Previous reports showed that the quality of proximal femoral fracture fixation and complications such as malunion, nonunion, varus deformity, and avascular necrosis might be associated with SCFE following the fixation.[2],[3],[4],[5] Ok et al. reported a case of a 6-year-old boy who developed SCFE following malunion of the femoral subtrochanteric fracture. They recognized the alteration of shear force on the epiphyseal plate responsible for the development of SCFE.[5] Li et al. presented two cases, a 12-year-old girl and a 6-year-old girl, who developed SCFE at five months and nine months, respectively, following screw fixation of a femoral neck fracture. They identified clinical factors such as implant irritation, early return to weight-bearing, delayed union or nonunion, coxa vara, and avascular necrosis to be possibly related to the development of the subsequent slip.[3]

It is important to avoid malalignment in proximal femoral fractures as a possible cause of SCFE following the fixation described by Chinoy et al.[2] They described a 5-year-old case presented with a diagnosis of SCFE following femoral neck fracture, which was closely reduced and fixed by Spica casting. They identified varus deformity after femoral neck fracture as a possible factor related to SCFE.[2]

Our patient was a healthy normal boy without any endocrine or genetic disorder. Furthermore, there was no evidence of SCFE on the X-ray taken at the time of the initial fracture. Thus, in our case, fracture union had been established, and fracture-related complications such as coxa vara secondary to fracture as the main contributing factor in the development of epiphyseal slip could be ruled out. In our case, the anatomic reduction was achieved perioperatively [Figure 7] and secondarily coxa vara was developed. It is may be due to obesity or other factors that were not obvious [Figure 4].
Figure 7: The X-ray immediately the following fixation showed that there is normal neck shaft angle after fixation

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Manukaran and Abdul Hamid reported a case of SCFE in a 9-year-old boy 14 months after internal fixation of femur neck fracture by cancellous screws. They identified the tip of the implant at the epiphyseal plate to be responsible for the slip.[4] In our case, the IT fracture fixed by DCP that precontoured operatively. It is possible that the bent plate developed SCFE subsequently, and it is suggestable using the anatomical proximal femoral plate in pediatrics IT fractures.

Previous studies showed that there are some predicting risks for contralateral unaffected hip SCFE such as higher epiphyseal tilt more than 10 degrees,[6] high BMI, younger patient age, and endocrine abnormality.[7],[8] Because of obesity, high epiphyseal tilt angle, and the young age of our patient, we decided to fix the contralateral hip prophylactically. However, a normal thyroid function test could exclude endocrinologic problems due to SCFE.

In conclusion, the proximal femoral fracture is a possible risk for SCFE following fixation. It is important preventing SCFE using appropriate implants and evaluating endocrine profiles following the fracture to reduce the risk of SCFE. Achieving anatomic reduction and alignment is one major component to prevent complications such as SCFE following the proximal femoral fracture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Marquez D, Harb E, Vilchis H. Slipped capital femoral epiphysis and hypothyroidism in a young adult: A case report. J Med Case Rep 2014;8:336.  Back to cited text no. 1
    
2.
Chinoy MA, Pal S, Khan MA. Slipped capital femoral epiphysis after treatment of femoral neck fracture. Pak J Med Sci 2020;36:S94-7.  Back to cited text no. 2
    
3.
Li H, Zhao L, Huang L, Kuo KN. Delayed slipped capital femoral epiphysis after treatment of femoral neck fracture in children. Clin Orthop Relat Res 2015;473:2712-7.  Back to cited text no. 3
    
4.
Manukaran MN, Abdul Hamid AK. Slipped capital femoral epiphysis caused by an implant – A case report. Singapore Med J 1989;30:406-7.  Back to cited text no. 4
    
5.
Ok IY, Kim YS. A slipped capital femoral epiphysis following ipsilateral femoral subtrochanteric fracture: A case report. J Korean Soc Fract 2002;15:526-30.  Back to cited text no. 5
    
6.
Maranho DA, Ferrer MG, Kim YJ, Miller PE, Novais EN. Predicting risk of contralateral slip in unilateral slipped capital femoral epiphysis: Posterior epiphyseal tilt increases and superior epiphyseal extension reduces risk. J Bone Joint Surg Am 2019;101:209-17.  Back to cited text no. 6
    
7.
Swarup I, Goodbody C, Goto R, Sankar WN, Fabricant PD. Risk factors for contralateral slipped capital femoral epiphysis: A meta-analysis of cohort and case-control studies. J Pediatr Orthop 2020;40:e446-53.  Back to cited text no. 7
    
8.
Swarup I, Williams BA, Talwar D, Sankar WN. Rates of contralateral SCFE in the United States: Analysis of the pediatric health information system. J Pediatr Orthop 2020;40:e587-91.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]



 

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