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European Radiology

, Volume 17, Issue 1, pp 163–168 | Cite as

Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results

  • G. StaatzEmail author
  • D. Honnef
  • A. Kochs
  • C. Hohl
  • T. Schmidt
  • H. Röhrig
  • R. W. Günther
Pediatric

Abstract

In this study we used contrast-enhanced magnetic resonance imaging (MRI) to evaluate the vascularization of the femoral head in children with slipped capital femoral epiphysis (SCFE) before and after cannulated screw fixation. Eleven consecutive children with SCFE, seven boys and four girls, aged 10–15 years were included in the study. There were no preslips; four children had acute, three acute-on-chronic, and four chronic SCFE. The MRI examinations were performed in a 1.5 Tesla MR scanner with use of a coronal STIR sequence, a coronal contrast-enhanced T1-weighted spin-echo sequence, and a sagittal three-dimensional gradient-echo sequence. Morphology, signal intensities, and contrast-enhancement of the femoral head were assessed by two radiologists in consensus. Morphologic distortion of the physis, bone marrow edema within the metaphysis and epiphysis, and joint effusion were the preoperative MRI findings of SCFE in each child. In nine children, the vascularization of the femoral head before and after surgery was normal. In one child, a preoperative avascular zone in the superolateral aspect of the epiphysis revascularized completely after surgery. One child with severe SCFE developed avascular necrosis of the femoral head after open reduction of the slip. We conclude that MRI allows for accurate evaluation of the femoral head vascularization before and after surgery in children with SCFE.

Keywords

Slipped capital femoral epiphysis Magnetic resonance imaging Hip Necrosis Children Skeletal system 

References

  1. 1.
    Exner GU (1986) Growth and pubertal development in slipped capital femoral epiphysis: a longitudinal study. J Pediatr Orthop 6:403–409PubMedGoogle Scholar
  2. 2.
    Loder RT, Aronsson DD, Dobbs MB, Weinstein SL (2000) Slipped capital femoral epiphysis. J Bone Joint Surg 82:1170–1188CrossRefGoogle Scholar
  3. 3.
    Weiner D (1996) Pathogenesis of slipped capital femoral epiphysis: current concepts. J Pediatr Orthop B 5:67–73PubMedGoogle Scholar
  4. 4.
    Hackenbroch MH, Kumm DA, Rutt J (2002) Dynamic screw fixation for slipped capital femoral epiphysis. Treatment results. Orthopäde 31:871–879 [German]PubMedCrossRefGoogle Scholar
  5. 5.
    Kumm DA, Lee SH, Hackenbroch MH, Rutt J (2001) Slipped capital femoral epiphysis: a prospective study of dynamic screw fixation. Clin Orthop Relat Res 384:198–207PubMedCrossRefGoogle Scholar
  6. 6.
    Futami T, Suzuki S, Seto Y, Kashiwagi N (2001) Sequential magnetic resonance imaging in slipped capital femoral epiphysis: assessment of preslip in the contralateral hip. J Pediatr Orthop B 10:298–303PubMedCrossRefGoogle Scholar
  7. 7.
    Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg 49:807–835PubMedGoogle Scholar
  8. 8.
    Lalaji A, Umans H, Schneider R, Mintz D, Liebling MS, Haramati N (2002) MRI features of confirmed “pre-slip” capital femoral epiphysis: a report of two cases. Skeletal Radiol 31:362–365PubMedCrossRefGoogle Scholar
  9. 9.
    Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD (1993) Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 75:1134–1140PubMedGoogle Scholar
  10. 10.
    Boyer DW, Mickelson MR, Ponseti IV (1981) Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am 63:85–95PubMedGoogle Scholar
  11. 11.
    Kennedy JG, Hresko MT, Kasser JR, Shrock KB, Zurakowski D, Waters PM, Millis MB (2001) Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop 21:189–193PubMedCrossRefGoogle Scholar
  12. 12.
    Tokmakova KP, Stanton RP, Mason DE (2003) Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis. J Bone Joint Surg Am 85:798–801PubMedGoogle Scholar
  13. 13.
    Rattey T, Piehl F, Wright JG (1996) Acute slipped capital femoral epiphysis. Review of outcomes and rates of avascular necrosis. J Bone Joint Surg 78:398–402PubMedGoogle Scholar
  14. 14.
    Peterson MD, Weiner DS, Green NE, Terry CL (1997) Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop 17:648–654PubMedCrossRefGoogle Scholar
  15. 15.
    Gordon JE, Abrahams MS, Dobbs MB, Luhmann SJ, Schoenecker PL (2002) Early reduction, arthrotomy, and cannulated screw fixation in unstable slipped capital femoral epiphysis treatment. J Pediatr Orthop 22:352–358PubMedCrossRefGoogle Scholar
  16. 16.
    Reynolds RA (1999) Diagnosis and treatment of slipped capital femoral epiphysis. Curr Opin Pediatr 11:80–83PubMedCrossRefGoogle Scholar
  17. 17.
    Aronson DD, Carlson WE (1992) Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am 74:810–819PubMedGoogle Scholar
  18. 18.
    Goodman WW, Johnson JT, Robertson WW Jr (1996) Single screw fixation for acute and acute-on-chronic slipped capital femoral epiphysis. Clin Orthop Relat Res 322:86–90PubMedCrossRefGoogle Scholar
  19. 19.
    Stevens DB, Short BA, Burch JM (1996) In situ fixation of the slipped capital femoral epiphysis with a single screw. J Pediatr Orthop B 5:85–89PubMedGoogle Scholar
  20. 20.
    Kenny P, Higgins T, Sedhom M, Dowling F, Moore DP, Fogarty EE (2003) Slipped upper femoral epiphysis. A retrospective, clinical and radiological study of fixation with a single screw. J Pediatr Orthop B 12:97–99PubMedCrossRefGoogle Scholar
  21. 21.
    Daschner H, Lehner K, Rechl H, Heuck A (1990) Imaging of epiphyseolysis of the femur head in the magnetic resonance tomogram. Fortschr Röntgenstr RÖFO 152:583–586 [German]CrossRefGoogle Scholar
  22. 22.
    Schittich I (2001) MRI in the diagnosis and treatment of Perthes disease and epiphysiolysis of the head of the femur. Orthopäde 30:519–527 [German]PubMedCrossRefGoogle Scholar
  23. 23.
    Umans H, Liebling MS, Moy L, Haramati N, Macy NJ, Pritzker HA (1998) Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation. Skeletal Radiol 27:139–144PubMedCrossRefGoogle Scholar
  24. 24.
    Maeda S, Kita A, Funayama K, Kokubun S (2001) Vascular supply to slipped capital femoral epiphysis. J Pediatr Orthop 21:664–667PubMedCrossRefGoogle Scholar
  25. 25.
    Mahnken AH, Staatz G, Ihme N, Gunther RW (2002) MR signal intensity characteristics in Legg-Calve-Perthes disease. Value of fat-suppressed (STIR) images and contrast-enhanced T1-weighted images. Acta Radiol 43:329–335PubMedCrossRefGoogle Scholar
  26. 26.
    Sebag G, Ducou Le Pointe H, Klein I, Maiza D, Mazda K, Bensahel H, Hassan M (1997) Dynamic gadolinium-enhanced subtraction MR imaging–a simple technique for the early diagnosis of Legg-Calve-Perthes disease: preliminary results. Pediatr Radiol 27: 216–220PubMedCrossRefGoogle Scholar
  27. 27.
    Lamer S, Dorgeret S, Khairouni A, Mazda K, Brillet PY, Bacheville E, Bloch J, Pennecot GF, Hassan M, Sebag GH (2002) Femoral head vascularization in Legg-Calve-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol 32:580–585PubMedCrossRefGoogle Scholar
  28. 28.
    Fragniere B, Chotel F, Vargas Barreto B, Berard J (2001) The value of early postoperative bone scan in slipped capital femoral epiphysis. J Pediatr Orthop B 10:51–55PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • G. Staatz
    • 1
    • 2
    Email author
  • D. Honnef
    • 2
  • A. Kochs
    • 3
  • C. Hohl
    • 2
  • T. Schmidt
    • 2
  • H. Röhrig
    • 3
  • R. W. Günther
    • 2
  1. 1.Department of Radiology, Division of Pediatric RadiologyFriedrich-Alexander-University Erlangen-NürnbergErlangenGermany
  2. 2.Department of Diagnostic RadiologyUniversity Hospital of the RWTH AachenAachenGermany
  3. 3.Department of Orthopaedic SurgeryUniversity Hospital of the RWTH AachenAachenGermany

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