Time to Physeal Closure after Screw Fixation for Slipped Capital Femoral Epiphysis
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Abstract
Background: The primary goal of treatment in slipped capital femoral epiphyses (SCFE) is to prevent further slip by stabilizing the physis. This is typically achieved with the use of a single cannulated lag screw placed across the proximal femoral physis to achieve stability and early physeal closure. If screw fixation causes premature physeal closure, it may impact the remodeling potential of the proximal femoral deformity that can occur with SCFE. The influence of this phenomenon on long-term outcome in SCFE is not clear. The goal of this study was to determine the time to physeal closure on the involved and non-involved side after single screw fixation in unilateral SCFE, and to assess factors that may influence this time frame to physeal closure.
Methods: Fifty-two patients with idiopathic unilateral SCFE who had complete radiographs until skeletal maturity were included. Anteroposterior and lateral radiographs of the pelvis and hips were assessed. The position of the screw was noted with attention to the location of the compression threads in relation to the physis and epiphysis, and whether the screw head was flush with the lateral cortex of the femur.
Results: Nineteen girls and 33 boys with a mean age of 11.7 and 14.3 years, respectively, were identified.
Time to closure on the treated side was 8.0 months SD (9,7) (range 0.4 - 52.1) and on the non-involved non-treated side 16.9 months SD (13,5) (range 0.4 - 69.1), which showed a significant difference (p = .001). Ninety-five% confidence interval for the difference was 6,0 - 11,8. Screw position, age, gender, degree of slip, or whether the triradiate cartilage was open or closed did not influence time to closure.
Conclusion: The remaining growth and remodeling potential of the hip after SCFE might be inhibited by the premature closure caused by screw fixation. We speculate that a non-compression device that allows further growth should be used in SCFE for the ultimate long-term outcome.
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Copyright (c) 2026 Riad J, et al.
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