Your browser doesn't support javascript.
loading
Capital Femoral Epiphyseal Cupping and Extension May Be Protective in Slipped Capital Femoral Epiphysis: A Dual-center Matching Cohort Study.
Morris, William Z; Liu, Raymond W; Marshall, Danielle C; Maranho, Daniel A; Novais, Eduardo N.
Afiliación
  • Morris WZ; Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Liu RW; Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Marshall DC; Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Maranho DA; Boston Children's Hospital, Boston, MA.
  • Novais EN; Boston Children's Hospital, Boston, MA.
J Pediatr Orthop ; 40(7): 334-339, 2020 Aug.
Article en En | MEDLINE | ID: mdl-32040063
ABSTRACT

BACKGROUND:

Peripheral cupping of the capital femoral epiphysis over the metaphysis has been reported as a precursor of cam morphology, but may also confer stability of the epiphysis protecting it from slipped capital femoral epiphysis (SCFE). The purpose of this study was to investigate the relationship between a novel morphologic parameter of inherent physeal stability, epiphyseal cupping, and the development of SCFE in a dual-center matched-control cohort study.

METHODS:

We performed a dual-center age-matched and sex-matched cohort study comparing 279 subjects with unilateral SCFE and 279 radiographically normal controls from 2 tertiary children's hospitals. All SCFE patients had at least 18 months of radiographic follow-up for contralateral slip surveillance. Anteroposterior and frog lateral pelvis radiographs were utilized to measure the epiphyseal cupping ratio and the current standard measure of inherent physeal stability, the epiphyseal extension ratio.

RESULTS:

Control hips were found to have greater epiphyseal cupping than the contralateral uninvolved hip of SCFE subjects both superiorly (0.28±0.08 vs. 0.24±0.06; P<0.001) and anteriorly (0.22±0.07 vs. 0.19±0.06; P<0.001). The 58/279 (21%) subjects who went on to develop contralateral slip had decreased epiphyseal cupping superiorly (0.25±0.07 vs. 0.23±0.05; P=0.03) and anteriorly (0.20±0.06 vs. 0.17±0.04; P<0.001). When we compared controls with hips that did not progress to contralateral slip and hips that further developed a contralateral SCFE, 1-way ANOVA demonstrated a stepwise decrease in epiphyseal cupping and epiphyseal extension ratio in the anterior and superior planes from control hips to contralateral hips without subsequent slip to contralateral hips that developed a SCFE (P<0.01 for each).

CONCLUSIONS:

This study provides further evidence that epiphyseal cupping around the metaphysis is associated with decreased likelihood of SCFE and may reflect increased inherent physeal stability. Epiphyseal cupping may represent an adaptive mechanism to stabilize the epiphysis during adolescence at the long-term cost of the eventual development of associated cam-femoroacetabular impingement deformity. LEVELS OF EVIDENCE Level III-prognostic Study.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Desarrollo del Adolescente / Fémur / Pinzamiento Femoroacetabular / Epífisis Desprendida de Cabeza Femoral / Articulación de la Cadera Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Male Idioma: En Revista: J Pediatr Orthop Año: 2020 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Desarrollo del Adolescente / Fémur / Pinzamiento Femoroacetabular / Epífisis Desprendida de Cabeza Femoral / Articulación de la Cadera Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Male Idioma: En Revista: J Pediatr Orthop Año: 2020 Tipo del documento: Article