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Early onset slipped capital femoral epiphysis in children under 10 years old. Surgical treatment with two different methods and results.

BACKGROUND
Slipped capital femoral epiphysis (SCFE) is a condition commonly affecting adolescents. It is scarcely reported in children under ten years of age, but it can be debilitating when misdiagnosed. Our purpose was to report the incidence and treatment methods of SCFE that were applied in our institution in children under the age of ten.


CASE SERIES
We retrospectively reviewed the records of patients with SCFE treated between 2007-2018 and excluded those older than ten years old. During the study period, 46 patients (49 hips) were diagnosed with SCFE, of whom nine patients (11 hips) were children younger than ten years old. The mean age at presentation was 8.25 years. The classification was made according to the Southwick slip angle and stability of the slip. Comorbidities and body mass index (BMI) were registered. There were nine milds, one moderate, and one severe slip. All but one case were stable. All the children were above the 97th percentile BMI for age. Three patients suffered from metabolic disease. In situ Kirschner wire (K-wire) fixation was used in five hips and in situ fixation with a single partially threaded cannulated screw (CS) in six. Only two complications that required intervention were recorded, one K-wire loosening, and one K-wire mechanical failure. The mean follow-up time was 40.1 (range: 10-74) months and included eight of the nine patients. They were monitored for pain, range of motion, avascular necrosis of the femoral head, and slip progression.


CONCLUSION
The diagnosis of SCFE should be considered in overweight children under the age of ten, with hip-related clinical manifestations. Treatment in this young group of patients can be demanding. K-wire and partially threaded CS fixation both provide stability and accommodate the femoral head's future growth. The use of K-wire fixation is recommended at a very young age (6-8 years of age). Orthopedic surgeons have to be aware of the increased risk of hardware-related complications when using K-wires that may have to be addressed surgically. HIPPOKRATIA 2019, 23(4): 165-168.