A dv aJ

u?,lufigt1{iltu Original Article

la u dff ? I I filJ :uul : n ut ? Ifl 'tt

tlAldvduil 5 quun 1 ilR:tnil-ttJu'tu1{ 255r

Mongkol Aungsathammarat M.D.

Department of Orthopedics

Sawanpracharak Hospital

Nakon Sawan

Sawanpracharak Medical Journal

Vol.r No.t fanuary-April zooe

-4aAserrdft 1 ? u f! u u R 1 : I 0 I Q, I gt u I gt 1, o.t fi ? R I u 9t fl gl u 1, 1 I n Gi o u m a otl e -'-- U-' --- ----n--

lul:sfl u ru 1 afi ? :rr{rJ :sur Yn dSlipped Capital Femoral Epiphysis in Sawanpracharak Hospital

vveil.qfla 0.0flfi::tJ:9t1{ ?{.u.

ta)RAil{1ilflAUR::ilR:UORI 'tt

I:r ns rura aa::rfij:snYndvvlo.rfi?oufi:fl?::n

uYrfiodo

inoiltvasF{I

cloluflflHl : naSJ\:',tuFlaafl:Tiln:sgn [:.:ila'turaar::nil:cu1:n$

grJuuuntrfi nur : nr:6nurr?.:rry::ruu'r__l_.i1- | e\ d ^ a f v e A *y- vflolJgl?ou1{ :,.111?ufl1?sF[ufln1:raTOMlu[n,Uodfi?n:cnnnuz'tmdaumanffLFnunr::ntn

i s { - - a- --' -- qi"- q -

'lul:.:ilElru1ad?r:d'il:rzrindfr.ouri run:rnru y{.Fr. 2sg8 6.: fumnru

u.fr. 2545

?fnltflftul I d 9n: :?u:?u?tauaalnt?t:vrfiaufrdru il:cnaufirEl o1?J ryrn rjrurin tf,or{q-

4flan1:flnur

uny:vriu nt1il?u rr:{fl a.:I:nniaemlt'{ri1 u ro nfl t:ri n'rffi tn uncnl:Ann1ru

nrtsum:nfrou- 9! Joo u Ci € a a f v e J: Elu? u7t?uaafl tuuRl?sF[uu n1:Lo:fu tau [n?a.:m,: n:sn nmu?1 tn6aufi a Ft

Gripp"o capital f"rorrt""piprrysis:JcrE)fi o r., tt trorl""irfl#;pimu g :1s (alqradn rs fly rfin{vr{{ 3 :.r?r 1a.n,"dn 1s fl) nu,ir

d,

+ marflutf,n acute-on-chronic dip 6n 2:.1EJ rflutfior chronic slip ri.,: 8

f, a adr r n rf, rlfi riu n d u stabte da u'[r ni n a1 il :u LL:\:? a.: nr : m fi a u ril u rru u

moderate stip (7'[u a f,oailil n1 lil fi {rJr a:r alorfi r}-umr nrr u fi nil n fi ra.,rr qyr r dZ v v oriarulila uriun:rufiriT vtinriarfiu 1rurnn.jr 95 percentite) {rJru4n:rulfi

v v ,t r vo r o

-:Un1::fl tr|n?tlfl 1:rJ10tO L6l cannulated screw fixation, in situ r{AnlTrnurl

riauflrt frtrifi nrrfi omt?Eumrn{ou1u u:.,:yt{ chondrolysis LLas avascularI

740 velu{f,a o{f,ttlrtnud, v d

6l?5:nU :sg1:fl 1*L'1f, 6tl :

A d I a ^ a f u e d Yey?orraiuauapJ : RmsFfutrrn:ra:rurrrutrma.,nflrn:vornfrurnrndoufiqn (scFE) r{uldfiaannn

tu rH nffl iulil EId.: rf, u n u ro rf, a :1 fl .:rud:ru :r u frrh fllfi nfi H.,: o :r Hlu:rErcqg

r?n1 I fl nr:i rn:rcf{o u alfi ,.r ahi un n oir':riufraru n 16 r.r nr:fnu scFE'lun{ru idiopathic,yp" ofi; stable rIogiufiarulfi Sngre central cannulated

screw fn<ation rn#ntnoclfit{ad udnrdtl.:rnrvuvnnfiau;rutott cfrondroty;isq

t-Lrav avemcular necrosis nmnirmfntfiumianarrudru looesity) zo.,:r6n6 q u A a v !o^ U

rfl urJo,r"fl mfi .:?ro{ n1:rn onrrv SCFE rm fi au rYu:'r urruii ridr EJfi'r o :r a{cd Y u a v Aa o u J efl ilR1?vU1fi U n lnu fl 1tn:?AilU ttav?UQA g:?tJ?]it [m n1::n1*1m n nnO.0

Lfi rJlrdal fi neT ar rir frruoo9Rl6lnnq : n1?8fl u Einr:rairu fiulntotfi-? nren n dutr rn daufi a n n?1 ruTu rl:t?rh: fl 1:

{u{qqJvv

Inaaufll?8fi ? n:vn nnufl 1 n1 EJ{

Abstract

Obiective

Setting

Design

Subiects

Method

Results

necrosrs

To study of patients with slipped capital femoral epiphysis (SCFE)

Department of Orthopedics, Sawanpracharak hospital, Nakom Sawan.

Descriptive study

Slipped capital femoral epiphysis patients in Sawanpracharak hospital

during January 1995 and December 2OO2.

Reviewed medical record and collected the following data including age,

gender, body weight, type and slip severity, radiographs, treatment and

complication

Six patients (8 hips) of slipped capital femoral epiphysis were reported.

There were three boys (average age, 13 years) and three girls

(average age, 13 years). Four patients had acute-on-chronic slips;

two patients had chronic slips. All hips were considered stable and

the majority of cases were moderate slips (7 hips). No patient reported

endocrinopathy or other systemic illness, but all patients were over

weight (> 95 percentile). All hips were fixed with in situ cannulated

screw. No cases of avascular necrosis or chondrolysis was seen in

this report.

Slipped capital femoral epiphysis (SCFE) is relatively uncommon hip

disorder conclusion in Thai adolescents. There were only 6 patients

Discussion and :

nr-rrgudnr:roiqrAr'[nra.rrirn::qndllrrndorxqalul:'rnururnar::rir]:;rindiifi S otiufi 1 il.a.-tr,.U. 2551 slipp€d capiral Femmat Epiphysis in Sawarprachmk Hmpital 7 41

in I years duration at Sawanpracharak hospital. The results were similar

to those reported by other authors. Most orthopedic surgeons currently

recommend in situ fixation with a single central screw fixation for

stable idiopathic SCFE. The results of this technique have been

excellent, severe complications (chondrolysis and avascular necrosis)

were less. Obesity is the important factor of idiopathic SCFE. All 6

patients in this series were over weight. Early recognition, diagnosis

and proper treatment are at most important.

: Slipped capital femoral epiphysis (SCFE), Slip severity, Avascular

necrosis.

Key words

c

ultu1

uacflud1 hiarrur:nnurn:rflIrnlfi rJoouu

6.,:fi u ri uil.i n1ila'nufus stability(4)

stable fthaoaarrur:orfiulfi amlfriliolrifro..:{6e A t A Y t

Ldrn:a{u2svrrhry{un{:ogac 90 d?unailqi

u nstabte oJlil a'rur:n r6u1fi a-nuatcal n1:dnUOlA

ilnAcN1Fl?Eln1:LnilnsHfl n (intermittent limp)eaJfr

ufir,r ElrEanlilaBrn nfi nrtn n uoi o1 n1:il? o

g

AnoflarJq

nmrqturin'r:roiqrfiulntatfi':n:vqrn riasriau{fliu (riasn'i1 I fl) il-nosfintac-"-'ci o { q \vAnu?lLnAauilqn (slipped capital femoral

epiphysis: SCFE) lflunarrufinrlnfidnu'jrfi

nr:rndouajlud?ufl4.: physeal plate riT'lfr

druso.,: femoral neao rndoulrjmrtfitumn-.:vtAd

ttara1ila1{ Lilotl]fl u fiudf uza.,: femoral neckoru,Aaaaf

yru-Lud2.0x ir?ufi il n1:taSE tnu [nta\: physisq

d:rorrir (early adolescent growth spurt)vo*Jat-a

LtneilflTtu LuLnnmilnl?rulfiuntnu (il1nn?'t

95 pe rcenti le) nutu tt t rffi'r Er u1 n n'j1 [y{ fl m €.,:

rfinriaa (1.5:1 1 arqdrrruturfin{trarodatvdt€rYAJrvlil1nu 12!1.5 U Lnnryilq{alslQaEjlll1nu

1 g. 5t1 . 7 fl t r I n u rfl urY.: ao.,:fi1.,:ia fl nc 2s-4gtzt

druvrnaEilundil idiopathic scre d.,:tri{q

rdq v r r dyt:1uf,1 114 n LLnilUOA U:',]ilfi A1 gO U1n FIAy

-'o v d u,]1?culilunrnu (obesity) nnuruenl:t:u{n?

uasa?1il fi errj n fi vrr,,:In?{i'h:?ot physeal&.).r

phte :rrrT.o nr:tdAuutLua{fl o{EailuulutvrYdtc

{?n? uTu Yt{uu FrtJ ila no allil u?lil u:{l?8.,1t -it,physeal plate ot-.,:tiufitnu SCFE turfina'ra

n?1ilfi nrrlnfirurriau tunrn endocrine

disorder tdu primary hypothyroidism,

pituitary dysfunction, hypogonaOism tflufru

nmuil.,rtfia (staging) aa.o SCFE'[uY^

rtu u oi.: 6 ru (trad itional classif ication ) tfr:rarnnrrto.:o1n1T(3' 4) firarnr:tfluilrfiafl n'ir g

#rlorrfda acute slip ornr:tflururrurnn'jr g

d'ilnt{60 chronic slip uavdrfiornr:ur,J1nn'i1 g #ilnrfdrruriufi arnr:ilreraclv'rna -Ztittluvlnu?unauil.toc6gn'ir acute-on-chronic

st ip uri nr: ur,i.: uu u dlri dvnr n si a nr:rirlr-flfi

Ly{T13:s?ls[?a1?18\:a1 nr:fnuonlfftrifo rou

742 vsau{Ra o{qrrrrtnu

c, v d6{? :: n il:c{1 : nut?{6'l:

c. )v davrlrullgtu?1 ?1?luufitordrfllfi nr:rhndadr,{nlnan:{asl rufio u n1:n:?ai1{fl 1 u [Las

n1:m:?4R1fl ta nfl t:Eilurir anteroposteriorf9tA

LLac frog leg view ?a{6{st1i{n 2 ?1:43f,?EUUEluAAeaA

n1:?uaau r[av[]1u n?1 ;J?u LL:{z a{n1:tn a au

(slip severity)

nlrinul SCFE firflrmmatdaflatu A & d oga anunl:LnnaurJln?lu LLacLilo LrtJnl:Un?a{

physeal plate'lun{il stable slip ttnmtinr.,:

aa5[oflfinddrulmrijfiarunrai, in situ fixation

firu single central screw ttauaslhloutS?

n1u'[u z-s iu drundr.r unstable slip(s)q

A Yevrfl ator nnulfiria u il1 n6.: ritlil fr f, a tJ n il1 n

r dr o tdd € aeo l1^r a rLgi LLlrn ErlruLuru nil nfl il t?1u $47tt internal

fixation

R1?suil:nfi au'[u:saru:nd fr o.::c{.:

Hanr:tfior chondrolysis(u) d.,:vlu16 Sasac +zA u a \evflunnnrrruluu:it?a{n1:tfi n stip doulfiiu

e

vaJn1:inu1 u5a nr:fr pin mia screw fixation

Yrcadru femoral head drunl'lc avascular

necrosis ?1o.1 femoral head tflunTsum:n

fioufi pu:.0fr zuarirarufioavlt^rnad1.,::?n 6?Aer.6eaJsoeCI\: nA'JTl U1 H1 il [3J L]l tn n?U [A U n1T Lfi n1:AA vYYd t v v d I o

zUAAU LFtLS?UAcrJlnA:nU1 mAntA g{n1T7l116

aggressive reduction uclnalnuLu:Eustl'l?

r6ndrflu scFE fiociluflilfi1 n?1&ra1??r1

lilMr6'u (limb length discrepancy: LLD) unv

fioarlr,rnrdail (osteoarthritis of hip)

dtufinmc scFE yrulfifiosturfin

unuLorfifl niuaon LtasmtfrHniuaantda.,:1fr

Lnflfi:1u.:1u?a{ vlTfaat 11 t :'rfl (9 toac[v{ n) uoi rrru dr rirg a {d fr omr:lfr uilm dt?u

,A% &u,yvr A A oeiloun n?LllTanL:nilil'rfl?ru d1u1:nLfin1T

vtyc J c5l u t raruQqu LFt r:? tvla g.la Fr Lufl 1::nu1 Lil tn nn1?u

n A a\v etL?t:fl {auyr:u rrT{ n1ilil1 a{ Lar?u:?utailaq{

ufi ndfi nrrv scFE ?a.:I:.,:vrs'rulnfl?r:,{d r du , s A o ail:su1:nu Lafl il?orfl U:ed{nLfl ou1il1 F[nu1

d v a tr d , r d9 u vA? rnr1rfi LLacuunnLilarfl url:dazririffi iu zun

au'[qoiahl

?fin1iflnu]a J* a

n1:F{nUlUtUUnlTF[nU1 tt.]1I::6UU1

(descriptive study) tfi orfraum a-.: fot a:ru:rruv d e n Jt --t0ilaa1nt?{:ctu flufl0.,10,111? un LnTU n1:{o

vtdtdAAf?uaa u?1 r1luR1?sFlu U n1:ta:[u LFru [4fl o{

{o

tir n:rn n fru'ur rnd au (sc FE) ?ro.:

I:,,:r{ ur ur a d2:: d'il:vtrind ot: ruoi 16 au

iln:1nil l'{.Ft. 2538 fitr60ufua1nil v{.Fl.dy h a t, u a y

2545 illllJ?Ejraflil{14&ln 6 :1EI UUnnsAilA

tuuuufufrn ilxnaufirtr LlIfi aru rirmrinn"aq

e r Ja. sf, aaslvr nfi rillul:n zfi oma.rscFE n?1rJi1J tt:{

q)?a.tn1:tn6ou (slip severity) nlTintlrt ttac

vovdatn?vtLnTnflflU U1?lOilAil1L:EIULTU\: LheLtOnLLO{{tfr a.,ir atu:ilr 4.,: nr:r.:g{

flaRl:flRU1

frrjegrfindrflu scre siru'ru 6 :18

ta fiaaslirn) (nr:1.,rd11 rflur6n{t1u s:14Ja.dea

(a1E]toafl 13 1l) Uarrnn{firu{ 3 r1u

(a1qraf,H 13 fl) In:1sfif1mrinrfiurdard.a@drv-r

ril5Eturflflunurotna1E$r1nu (eJ1nn?1 95

percentile) lilvru rnr ru fi or rl n fi ta.,: oi a rutivi o

,i'no-a1un{il idiopathic SCFE nu'irrilufro

aslnnmruardrs rvirriuadr.:as 2 :1s unscr,Acra6tlrA

riluyr..r 2 31{ 2 71il natilu:auas 33.3 LtJo

fi or:rur or nil:crGro.: frr.h Efl u'ir:cEcL? a1

ufl 5 auuYr 1 il.F].-ril.s. 2551

nr2sfludn1:lo5^iurAulnrolri':n:lqndutln6aunqalul:rrouroa:::rirl:;minJSlipped Capital Femoral Epiphysis in Sawanpracharak Hospital 7 43

JdAL[ncE1 fl 1:Yt rJ'r IU U n1 T t n A O U LtU U

acute-on-chronic 4 :1U L[As chronic 211!-)&d

tT.:urunrilutfi n stable Ly{T1sd1aJ.t:nr6u1da YYi Oe Cn{HJzuU?ElUl\::1U [Utn?O.il?IFl{ n1:n:?AT1{

nr aza.,: firh Hil n:1 fl avuu fi nr:aru rf, a 6afiq q {uj-AYer

il ilnfl n,J ril8? n n1TLnfi oulmrto.,:flaarlvr n'[uq

yirnrtzraan (hip abduction) rLasfisJu{a

aslnnltrfirutu linternat rotation) n:rfidlfl uvdvA*&teradfl1{ ta u??t1?t1it?l LuuQsn du n?1?1.:u n a [a n9duafl a1nfl1fl Lanclt:EtT{un?1il:utt:{?oitfl1:

rndaudautmduilu moderate stip 1z tu Ifi a aub,r n I 4 n :r ertffiu n r rin tn 6e u n 1 ? e.i 1 Fr"Fr

'[d cannulated screw fixation Inukiriroe A

reduction "[{tn5at fluoroscope drazrucytr

n1:rJ1na,.lanm:flB1a1nn1:nnn1illQau:cErs

t?41 2 fl {thsUnflE:v{ufi physeal fusion

1*jrwo'',,",L,ntl,d1uu:irt{ cnonorotysts

[av avascutar necrosis tu:radrfl uf,r.,:rdEJr

o*fi orrlqul Ft?1 &r ul?r{rj ryh rYulht drj ufi u

z L{uArilfl:) unsflrhjvrudnuruvra.:f,o

arlnnrdaru (pJd r-01

urrirdour-j.,:0r1il stabitity rt: e flaaih\nriluzfi or stable n1tfl u1n:cril:nosdn'irnriru

q

unstable Ia nrarfi an1?vLrytrnfrau6oYYt,aau

il?n:&annufl1Fl18uoun?1il1fl n1:?uafl uq

a 1 n fl 1 v'l r a n v r: rio c rfl u n-r ti? fl In El d{ r a n 1, L: ri

tuyir anteroposterior $nr frog leg view to.,:

aclfln z {r.: n:2an#nwsuc6irFi6u6a Klein's{U

line uac blanch sign za.,: Steel(') oslilu

a-fl ufugLeil1sfl a{R1?s SC FE u, noa ndoailcJ

tA fl CIt:fl AcU 8 n n?1 il:U U:.:?A{ n1:LnA OU

(stip severitv) fi z ifrdfiErulfi idu:nnnrn{Grurrunr:rufrurts'ror firriasn'il t/g 6sn'ir

mild slip firrurnn'jr 1/3 uririafln'jrtlz fifln'jrmoderate slip uarfirrurnn'jr t/z risn'jrsevere slip druidd z q!a1nn1:?-a

epiphyseal-shaft angle ?to{ Southwick

rGaurfi auniudr.:ilnfi frrriasn'i1 go a.:Ft1

rrirnTu milo firlfi 30-so a.,tFn 6a moderate

uacfirilrnn'jT so a.0FI1 60 severe n:rflr{luA v 6e t

ri.,: e {r.: 'lfirir 12 a{Ftlrilurirn'lunruo lo -o-lu:'r u.,:r u fi'lfri 6 rr: n uavil u d?u'[u ni rfl u

moderate stip firfiat 1 r'ta fiarfin{nfi..:

rlud 3 uilu mito stip n?1lt:uu:.orJrni:Atvdrrl

LnAAU nOUnlT:n1*18ttl r{A tn g Ol:.1n4 tA n16l

tfinnmc chondrolysis uasfizua'lu:cusfia{

ri anrrrdru rdu nr:ln d aulmrza.,:fl a avln n{s

In s ral,{rsnr:m ruu r{r firutu nmcfl r#u umq

ad?o1tol

6.: urfi'irn'rac SCFE onrutfrfi a erarr n

'[ul6nln Hd.:r{lu pru ra rfi a rl n fi uf,t ru'[u16n

firrir lotact<) mia pognesian tdiloun'j1il1nX vn tv d o

T1 Ei.:1UUT?UT? 3J r,JU? U Ln ty{ El.] 6 :1 El LU:celcdr de tle { r ' f ' r v A

t?a1 8 il n1:?tn:1sfi?oilaLnrJaLilLtFlnnl{ LtJtYtlflu u{tt1l:r,ru0r1rJ:voun21il?uLt:{flaitvea&AVuranu'[aila[dil?r.:L5o{a1fl tv\Fl u1fi un drugil0r

?ro.: SCFE'[u:rH.-rrudilun1:rndauttuu

acute-on-chronic 4 T'lEl una chronic 211'1)d d d u u,-,t,

nta til5ttu tyt HU nu51 u\t1u?la{ y{:f, H(', } Yt.,] 7 :1 Et

srip drirl#rfi o#nr*ars?.ilir.,:r4.,: femorat neck

broadening, shortening uac varus deformity

n,lT:-nHl scre'lun{il idiopathic typeAAa?zvrdaat

{uFr stable HaFlnulgaufi a\:v{u?1il{fi n15

inurrnrattuufia lnternal fixation (pinning)1o flaaah^r n) tfl u acute-on-chroni. ti,,:rrr,r,

744 ouar{Ra o{ffi::r:nil

d, v cd?:?nu:&t1:nu[?fl611t

in situ fi':a single screw mia muttiple pins/

screws(*") Bone graft epiphyseod"alr(tz'ta)

Corrective osteotomy(14'1s) [La- Spica cast

tauadroa9afl u€usoh:fl a1?tfi ilaunuFtailuTc? nfi nailil1

t A a A tei vnouna rnnflHTt 1 uav 3 url{u2Ejil1:un1Tu tl r r e A t Gt led:n1*1 [il41tr,] 7l']1J010[1lU[y{l1s[niln1:9lT?0

immobilizatlon(ro'ra uoiflolu-ufietrutfi single ,r1fl[an{r:dd.,:orrfiunarrufiorlnfi 6.:rrr]1fr

central cannulated screw fixation nt:reduction ovhirirnta firrir fi fra.tttuuf, ilu'ra

- & y', &(gentle manipulation) O.:UU{tJ??lYl.1 6 TIUatea e Aa) a I u6.,:1ff 16 a n nr :fn urfi 6 fi q or 6 a nr : air d'or'[d

Av&cannulated screw fixation fi':nr:fnurriulfi

.aVfr.aY&ila n Lil Tlu?1 rJRl?cuil:nqf ou?u u:.,:11.,:

chondrolysis uar avascular necrosis fin'ilAvJdnnrunr:inu.rLqdfl 2 tl fi physeal fusion

7tfl:19q

Vuaaetn?8iJlfiUnlnufi TAn?lila?u (obesrty)

d6.qvAzo.:6n Ltlurloo'sfi fi.,rrairnl:rfi oRms SCFE

A - ! ou E aatl4u0ilnuflUillilU ryU?Un',: 6 :1tl neJRl?cY - Jo q

rirurin rfi u fr rlurlooriu r6ntn erfi uuaftiruq

q d e -i I -Aacfluilolfiltnno2utluJillntu n{uun?1il

; E v &t ar "la,a €r?r :J?u Fl? a n,lu:? il 6{I:nmr.,:o o5[o'i]l 6 n dA- u ciu d e d f A aTl6ltlYllU0'nUtnnO2UA n [Tn?1U{nO infantile

tibia vara (Blount's disease) firjrocfinr:finvt9tvn?flt{unil

floufrdT rnrs scFE oatnniatilurfinlnEr

un n rimmJfi uh rtrlrt rir o r'lfr n ar ru aulo rv{r1 &

fr[anraocv{u rirla s r{lu nu u:n firhiio-n racd df Xa 5l9 aa u oocreuunn{L:nuna1o lfi n1:?uoagila1n n1 111 tF]tu

v t e gt- , %n1::fl MA1{1 Th:UAnUfUvu:s'tFrUAsOlnlt

aAd,%60?ra.:dnfr rrly{uomfr rnflhcaualmrfi ndnfiogtq

rdu nr:nnfrru rioufi a'rnr:il?ndJlvlnu?rmEi9aaon0.ilailAAEltLsflmn epiphyseal plate injury

LLffs Salter Harris type I ?oit femoral headJaa v I u o JsaEf{?fi'n1::nulasunnnl{nu [u:1?lit1uufl tJ

mfi fi o#ilritfi fi a#unlfrnu uvmrios5[6{] fi ndrry

t?gn:?aqagua'l

flrilq

ridr u rfinr-aiudyrunrrr sc FE{q

.iruru 6 :1 g rT".:mr.r01fiiu nr:r.iroioinu'ld

cannulated screw fixation Hanr:;nutdrundv 'A v &Lil tn nR1?cutlTnclau:utt:,,:tt.: chondrolysis

LLas avascular necrosis nt:n:?o?tuLtasAA e &dy v A y?UAO EI:? iln\: [m n1::nU1mO fl m A\: tfi tJ'lrfltJ

osdl u a aR1?sLtm:nfi ou oi.,: nrire n"'sutuY d ! ,r e a aY vfilTlu tn n1?{? UIU ?U:'l\:A?Ufi :OilU1fi Unqg

il1 n n'i1 rdnn'r}l m fia erol n1: rhuncrzua na.vatuad99aa1oilu:r2nu:sduqu nrfi 4 La nua s tta?il

a1nril?nfium mfifiu nir uto aslvrn lfrfinfi{nmc slpped capital femoral epiphysis

(SOFE) oqlunr:ifiodauanl:nfirfl rcila

d.) v ) nr'lcqurinrliiqrfiulntoifiln:cnndutrrndoumnhl:uurrranr::riri:snindtifi S ouTufi 1 il.n.-tU.u. 2551 Slip@ Capiul Femorat Epiphysis in Sawupracharak Hcpital 7 45

toRCntol{o{

1. Loder RT. The demographics of slipped capital femoral epiphysis: an intemational

multicenter study. Clin Orthop Rel Res1996;322:8-27.

2. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital

femoral epiphysis: a study of children in Michigan. J Bone Joint Surg (Am) 1993; 75:

1141-7.

3. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capitalfemoral

epiphysis. J Bone Joint Surg (Am) 1991;73 667-74.

4. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital

femoralepiphysis: the importance of physeal stability. J Bone Joint Surg (Am) 1993;

75: 113;4-40.

5. Aronson DD, Loder RT. Treatment of the unstable (acute) slipped capital femoral

epiphysis. Clin Orthop Bel Res 1996; 322: 99-110.

6. Lubicky JP. Chondrolysis and avascular necrosis: complications of slipped capital

femoral epiphysis. J Pediatr Orthop 1996; 5: 162-7.Y f a., a eA v 6: f a u A7. y{':tH {aflqnu, ?[ttE m1m[aT6uf,3Jum, ?InJu rJl{1ttnLaFnflU',t, z1alnfl 4rnfuQuilrnn.

Slipped capital femoral epiphysis in Ramathibodi hospital. J Med Assoc Thai 1997;

80(7): 446-52.

8. Steel HH, The metaphyseal blanch sign of slipped capitalfemoral epiphysis. J Bone

Joint Surg (Am) 1986; 68: 920-2.

9. Aronson DD, Carlson WE. Slipped capital femoral epiphysis: a prospective study

of fixation with a single screw. J Bone Joint Surg (Am) 1992; 74: 810-9.

10.Ward WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for

slipped capital femoral epiphysis. J Bone Joint Surg (Am) 1992; 74: 799-809.

11. Riley PM, Weiner DS, Gillispie R, Weiner SD. Hazards of intemal fixation in the

treatTent of slipped caprtal femoral eprphysis.J Bone Joint Surg (Am) 1990;72:150G9.

12. Weiner DS, Weiner S, Melby A, Hoyt WA Jr. A 3G-year experience with bone graft

epiphysiodesis in the treatment of slipped capital femoral epiphysis. J pediatr

Orthop 1984; 4: 145-52.

13.Ward WT, Wood K. Open bone graft epiphysiodesis for slipped capital femoral

epiphysis. J Pediatr Orthop 1990;10:14-20.

14. Abraham E, Garst J, Barmada R. Treatment of moderate to severe slipped capital

femoral epiphysis with extracapsular base-of-neck osteotomy. J Pediatr Orthop

746 tno 6{ni<nhd d2ff6il:c''r}infi?td1:

1993;13:294-302.

15. Fish JB. Guneiform osteotomy of the fenpral neck in the freatment of slipped capital

femoral epiphysis: a follow-up note. J Bone Joint Surg (Am) 1994; 46: 46-59'

16. BeE RR, Steel HH, Emper WD, Huss GK, Clancy M' Treatment of slipped capital

femoral epiphysis: spica cast immobilization. J Bone Joint Surg (Am) 1990 ;72:

587-600.

17. Meier MC, Meyer LC, Furguson RL. Treatment of slipped capital femoral epiphysis

with a spica cast. J Bone Joint Surg (Am) 1992) 74: 1ffi2-9'

oC(Uo-o().aE-co)c(l)

-oEil

oJJ

d.) v ) nr?&flurinrsr0itulaulnrolfirn:v4ndutrroa'ounqnlul:rnururaar::drJ:avriniilfi S quTUfi 1 il.n.-t:J.tl. 2551 Slip@ Capital Femoml Epiphysis in Sawanpracharak Hospital 7 47

oJJ

=oLo@

oq)(6fEc(UC)

oE)c6

o(d(I)EoE

oo(ga.()co-c.O

$r

.ocoL-CC)

aC-}E)a(G3CcrF

oro

(f)r

o2(eas

oE

oE(E

a,oco-co

ICoI

(I)

=()(d

Nrr)

(9r

o7(e,F

oEoooE

oE6a.9Co-c()

IcoIo=Q(U

-c!F

C\I(o

(f)r

d(-F

o(d(l)EoE

oE6a

.OcoL.Co

IcoI

(l)

f()(d

d.C=€."srt 6(c 2rc+=-<t-e.oF

o(o

Nr

E(-F

TE-=

=oLoU)

oo(U

fqc(6ooo).cct)

o6oooE

OreJ-=J,J

=@g)=6EU'8^ E:ot(6E'6 =(gE--=L

Eoqov -o)(\tc6

IA-e,J

=oLo<t)

EO^c6d-= '6E.s(EvC)

oE)C6

o$-c!F

il-)El

!oro

cf)r

a(eaF

(o

GH=s'sE

E.Cd lretr"(-G

?Fl/: '=

=ofroc o=

ct)

F.gcO

6(s o,d=(UFO

G

=HIG(a

)Farh afi(-

-= h=

ill" ^ctitCJV

E=J

-TFil(-lr"

ilI-rD(o

Fc-

=(-o(e

0LLOU)

.aU)

-co_'ao(tr

oEo6.=o-d()Eoa.gaF

u?nF

CUG

ilc9

)3eqGF(G;zd(a

)F

rF2C|.c-q

748 ve2u{na o{nf::tt:ou

C, u (d?T:nil?&t1TnUL2nd1?

.J € t u v t,

;r-Jfi r (1A, 1B) nlflLantt:fnr:rjrd'n Singte cannulated screw fixation (in situ) aa{fril?Eli6eata

:1et?1 1 tnnrJ{1Er 12 U ,,J'tFtoSsEtsr?a1H't{nu 5 tnau{

,A cah i?llyr 2 (2A-2D) fl1y,{raflflr:flryU'trnlun Z r6n{rra rS fl (1fimfl?arrfthEJ:rgd rl nhd'nld

cannulated screw 2 Fi?

nrlsOrdnltrn:0JrAu'lntorfirn:rqndutrrndourqnlu'l:lntlruraar::riil::minfCapital Femoral Epiphysis in

gr.lfi s (sA-3D) fl1r{Lan{r:rf{rlra:rufd + r6n{u{t ts fl tfluytu.,t z flrt rhor-ntrtarun-u'ld

Single cannulated screw fixation (in situ)

gUd o (4A-4D) R,rilmnf,L:Ei {rJru:rufi s r6n{mu t+ fl nt. scFE fnutird'orki sinsle

cannulated screw

;1fi O (6A-GD) fl1y,1r0flf,1:tf{rJrumufi O r6n{ufr.,: tg fl tflu Cntonic, stable SCFE, u ov El - j

- arirnoLLd single cannulated screw vtlult fusion Lila[?41 I tnau