[Complications after dynamic in-situ fixation of the femoral head in patients with slipped capital femoral epiphysis].

Abstract

Background: Slipped capital femoral epiphysis (SCFE) requires surgical treatment. In German-speaking countries, dynamic in-situ fixation is commonly used for mild SCFE lenta. Various implants are available for this purpose.

Objective: High complication rates have been reported for the removal of titanium gliding screws. In this retrospective study, we analyzed the complications in the treatment of SCFE, particularly focusing on the removal of sliding screws made of stainless steel and K‑wires.

Materials and methods: A total of 111 patients with SCFE were treated, including 96 fixations using stainless steel sliding screws, 93 wire pinning procedures, and 69 hips treated with a combination of both techniques. Additionally, 43 Imhäuser osteotomies were performed. Complications arising from these treatments were analyzed.

Results: In 14 patients, 23 complications were observed. Avascular necrosis of the femoral head occurred in three cases. Two patients sustained a fracture of the proximal femur. One patient presented with soft tissue irritation following fixation with both sliding screws and K‑wires. Infections occurred in three patients. Due to implant misplacement or breakage, 6 patients required a total of 12 revision surgeries. Two patients developed postoperative hematomas, which were surgically evacuated. No complications were observed related to implant removal.

Discussion: The issues described in the literature regarding the removal of titanium screws were not observed with stainless steel screws. This difference can be attributed to material properties: titanium screws have lower torsional strength and require higher torque for removal.