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Chronicity of initial slip
4%
114/2987
Height over 180cm
1%
40/2987
Age over 12 years old
110/2987
Renal osteodystrophy
89%
2649/2987
Elite athlete
2%
55/2987
Select Answer to see Preferred Response
An indication for prophylactic in situ fixation of the contralateral hip for SCFE would include renal osteodystrophy. The most common factors shown to increase the risk of bilateral SCFE include hypothyroidism, renal osteodystrophy, male and younger age (<10 years old). Riad et al. retrospectively reviewed the records of 90 patients with SCFE seen between 1990 and 2002. Twenty patients (22%) had bilateral SCFE at presentation, and 70 patients (78%) were unilateral. Of these 70 patients, 16 (23%) later de- veloped a contralateral SCFE. All girls younger than 10 years and all boys younger than 12 years who presented with unilateral SCFE developed a contralateral slip. Whereas, No girl older than 13 years and no boy older than 14 years developed a contralateral slip. Jensen et al. reported on a 20 year follow-up of 62 cases of patients with SCFE. At first presentation, 5/62 patients had bilateral SCFE. Further, 9/57 patients had slipping diagnosed in the contralateral hip during adolescence 1-3 years after the primary operation. At the follow-up examination 20 years after the primary operation, radiographs showed bilateral sequelae of slipping in 30 of 62 patients. Wensaas et al. reviewed sixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years. Results showed the clinical outcome was good in 35 patients (69%), as defined as when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. They also showed that corrective femoral osteotomy did not improve the outcome in hips with large slip angles and acute SCFE had poor outcomes. Thawrani et al. reviewed the current practice for the treatment of SCFE. 277 members of the Pediatric Orthopaedic Society of North America responded to the survey. They found that surgeons in academic practice, surgeons with ≤15 years in practice, and surgeons treating greater number of SCFEs are more likely to use SHD to acutely reduce the slip. Incorrect Answers: Answer 1: Chronicity of the initial slip is not an indication for prophylactic in situ fixation. Answer 2: Height is not an indication for prophylactic in situ fixation. Answer 3: Age < 10 would be considered a relative indication for contralateral pinning Answer 5: Elite athlete is not an indication for prophylactic in situ fixation.
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