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History of osteotomies around the hip joint and their classification
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
An osteotomy (either pelvis or hip or both) is a procedure that can circumvent the need for any definite treatment in a large proportion of patients, since anatomically abnormal hips do not last a lifetime. This is extremely helpful in conditions such as developmental dysplasia of the hip, Legg–Calvé–Perthes disease, slipped capital femoral epiphysis, osteonecrosis, and trauma, which lead to secondary arthritis of the hip joint, hence the importance of early diagnosis for these at-risk hips.
Paediatric orthopaedic disorders
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Slipped capital femoral epiphysis is caused by posterior displacement of the upper femoral epiphysis on the metaphysis and is the most common adolescent hip disorder. It occurs most commonly in obese boys. It is broadly classified into stable and unstable slips. Stable slips are slips in which the patient is able to weight bear on his hip albeit with some pain or discomfort. Unstable slips are slips in which the patient is not able to weight bear even with crutches and behaves like an acute fracture of the femoral neck. In its stable form it can present as knee pain over many weeks leading to multiple non-diagnostic radiographs of the knee joint on the part of the general practitioner. A chronic stable slip can turn into an acute unstable slip that is more prone to complications like avascular necrosis of the femoral head. Treatment of this condition is surgical in the form of fixation of the slipping epiphysis with one or two screws to prevent further slippage or a sudden acute slip.
The lower limb
Published in Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson, Emergency Care of Minor Trauma in Children, 2017
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson
This condition is also known as slipped capital femoral epiphysis. It presents with thigh or knee pain. It occurs when the unfused epiphysis of the femoral head slips position. It happens around age 8–15 years (earlier in girls because puberty is earlier). It is more common in boys than girls and both hips can be affected. Two body types are classically, though not necessarily, associated with this condition: ObeseTall and thin
No increased mortality after total hip arthroplasty in patients with a history of pediatric hip disease: a matched, population-based cohort study on 4,043 patients
Published in Acta Orthopaedica, 2021
Miriam G Wadström, Nils P Hailer, Yasmin D Hailer
Altered morphology of the hip joint due to pediatric hip diseases, e.g., Legg–Calvé–Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), or developmental dysplasia of the hip (DDH) is closely linked to early-onset, secondary osteoarthritis (OA) (Jacobsen and Sonne-Holm 2005, Pun 2016) which may lead to total hip arthroplasty (THA) at a young age (Froberg et al. 2011). Thus, the mean age at THA surgery in patients with a history of pediatric hip disease ranges from 38 to 55 years (Traina et al. 2011, Engesaeter et al. 2012), whereas it ranges from 65 to 70 years in patients with primary OA (Engesaeter et al. 2012, Fang et al. 2015, Cnudde et al. 2018). Studies from Nordic countries report that between 4% and 9% of all primary THAs are due to pediatric hip disease (Engesaeter et al. 2012).
Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995–2016
Published in Acta Orthopaedica, 2019
Vera Halvorsen, Anne Marie Fenstad, Lars B Engesæter, Lars Nordsletten, Søren Overgaard, Alma B Pedersen, Johan Kärrholm, Maziar Mohaddes, Antti Eskelinen, Keijo T Mäkelä, Stephan M Röhrl
One-third of the patients had pediatric hip disease. The increase in the number of pediatric hip disease indications cannot be explained by changes in DDH screening since the screening programs have been unchanged over the years. Neither have any changes in the incidences of Perthes disease or slipped capital femoral epiphysis been reported in the literature. There are also differences between the countries concerning pediatric hip disease as indication, but a study of hip radiograms at skeletal maturity showed that the prevalence of developmental dysplasia of the hip is on the same level in the Nordic countries (Engesaeter et al. 2013). Moreover, Lohmander et al. (2006) has found for all ages that there were similar THA indications in the Nordic countries. A more stringent diagnostic approach might have taken place in some countries and over the years, explaining the development in this indication.
A new compound heterozygous mutation in a female with 17α-hydroxylase/17,20-lyase deficiency, slipped capital femoral epiphysis, and adrenal myelolipoma
Published in Gynecological Endocrinology, 2019
Fan Yang, Yongting Zhao, Jie Lv, Xia Sheng, Lihong Wang
Previous studies have shown that 17-OHD is caused by a mutation in the cytochrome P450 family 17 subfamily A member 1 (CYP17A1) gene. The deficiency in this enzyme results in the reduction of glucocorticoids and sex hormones, accompanied by the accumulation of mineralocorticoids. Patients present with hypertension, hypokalemia, and hypergonadotropic hypogonadism. Females are usually sexually immature, and males exhibit pseudohermaphroditism. Females with 17-OHD are normally considered infertile even though occasional exceptions exist and have recently been reported [3]. Due to sex hormone deficiency, epiphyseal arrest is delayed, and the patient’s final height is usually increased [4–6]. Previous studies have shown that sex hormone deficiency disorders are associated with slipped capital femoral epiphysis (SCFE), which rarely occurs in adults [7–9]. However, SCFE has not been reported in 17-OHD patients to date. Moreover, adrenal myelolipoma (AML) is a benign adrenal tumor, which consists of extramedullary hemopoietic tissues and mature adipose tissues. At present, there are a few reports of 17-OHD associated with AML, but the pathogenesis of CAH leading to AML is not yet clear.