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There is limited evidence on the outcomes of Total Hip Arthroplasty (THA) in Slipped Capital Femoral Epiphysis (SCFE) patients. This systematic review aims to evaluate the current literature in terms of survival rate, functional outcomes, complications and types of implants of THA in SCFE patients. Following the established methodology of PRISMA guidelines, PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE were systematically searched from inception to September 2018. The search criteria used were: (“total hip arthroplasty’’ OR ‘’total hip replacement’’ OR “hip arthroplasty’’ OR ‘’hip replacement’’) AND (‘’slipped capital femoral epiphysis’’ OR ‘’slipped upper femoral epiphysis’’ OR ‘’femoral epiphysis’’). Ten studies were finally included in the analysis and were qualitatively appraised using the Newcastle-Ottawa tool. Variables were reported differently between studies. The sample size varied from 12 to 374 THAs. A total of 877 patients undergone 915 THAs. The mean reported follow-up ranged from 4.4 to 15.2 years and the mean patients’ age at the time of THA from 26 to 50 years. Four studies specified the type of implants used, with 62% being uncemented, 24% hybrid (uncemented cup/cemented stem) and 14% cemented. All but three studies reported the mean survival of implants that ranged from 64.9% to 94.8%. A limited number of complications were mentioned. There was a tendency for more favorable functional outcomes in modern studies. Modern THA-studies in SCFE patients showed improvement of survivorship, clinical outcomes and patient satisfaction. Future higher-quality studies are necessary to estimate long-term postoperative outcomes better.

Background Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in children 9–15 years old. This is a population-based study in Sweden presenting the epidemiology for SCFE. Methods In a prospective cohort study, we analysed pre- and postoperative radiographs, medical records for all children treated for SCFE in Sweden 2007–2013, demographic data, severity of slip and surgical procedures performed. Results We identified 379 Swedish children with primary SCFE 2007–2013; 162 girls, median age 11.7 (7.2–15.4) years, and 217 boys, median age 13 (3.8–17.7) years. The average annual incidence was 4.4/10000 for girls and 5.7/10000 for boys 9–15 years old. Obesity or overweight was found in 56% of the girls and in 76% of the boys. As an initial symptom, 66% of the children had hip/groin pain and 12% knee pain. At first presentation, 7% of the children had bilateral SCFE. Prophylactic fixation was performed in 43%. Of the remaining children, 21% later developed a contralateral slip. Fixation with implants permitting further growth was used in >90% of the children. Femoral neck osteotomy was performed for 11 hips. Conclusions The annual average incidence 2007–2013 in Sweden showed a mild increase for girls. The male-to-female ratio was lower than previous regional data from Sweden. Overweight or obesity is one major characteristic for boys with SCFE but to a less extent for girls. Knee pain as initial symptom cause a delay in diagnosis. Most hospitals in Sweden treat <2 children annually.

Background Pediatric habitual patellar dislocation in extension (E-HPD) is a rare and specific form of patellar dislocation with limited reports in the literature. For children with immature epiphyses, the gold standard for E-HPD surgery has not been established, and the appropriate treatment is controversial. We report three cases of pediatric E-HPD with epiphyseal immaturity and explore the etiology, risk factors, and treatment of E-HPD in children. Methods This article describes three cases of children with E-HPD whose epiphyses were not closed because of skeletal immaturity. The children ranged in age from 7 to 11 years, and all were female. Two patients underwent a combination of medial patellofemoral ligament reconstruction and lateral retinacular release, and one chose to continue conservative treatment. Clinical outcomes were assessed using the Kujala, International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale (VAS) scores and presence of patellar instability, and radiographic data were collected from medical records. Results One patient chose to continue conservative treatment, but the patellar dislocation did not improve. The other two patients were treated with medial patellofemoral ligament reconstruction and lateral retinacular release. Both patients had good outcomes with no recurrent dislocations during their respective 14- and 29-month follow-ups. All postoperative scores (Kujala, IKDC, Lysholm, and VAS for pain) significantly improved compared to preoperative levels.

In Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck. During 2008-2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Nötzli 3-point [alpha]-angle, the anatomic [alpha]-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA. Mean and SD values for the change in HSA were 3,7[degrees] (5,0[degrees]), for 3-point [alpha]-angle 6,8[degrees] (8,9[degrees]), and anatomic [alpha]-angle 13,0[degrees] (16,3[degrees]). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups. We found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling.

Slipped capital femoral epiphysis is a shearing injury through the growth plate of the proximal femur and is the most common hip disorder in adolescence. Delays in diagnosis persist across practice settings despite ongoing innovations in imaging. Recent insights into pathomechanics highlight the importance of femoral head surface morphology and rotational microinstability centered at the epiphyseal tubercle in causing early physeal changes, which can be detected on imaging prior to frank slip. Scrutiny of physeal morphology and comparison to the contralateral hip is critical at all stages of disease progression, and improper technique may result in undue diagnostic delay. Selective use of cross-sectional imaging can be helpful for troubleshooting equivocal early slips and can inform operative technique and adjuvant therapy candidacy in more severe cases. This review provides a comprehensive approach to imaging suspected slipped capital femoral epiphysis, with an emphasis on early detection and potential pitfalls.

The forearm function in children is influenced by several factors, with the length relationship between the ulna and radius being particularly important. However, due to the underdevelopment of cartilage in children, assessing this length relationship through imaging techniques is challenging. This study aims to identify a reliable method for evaluating the lengths of the ulna and radius in children, establish normal values for the ratio of the epiphyseal plate lengths of these bones, examine this ratio in children with Monteggia fractures, and investigate its role in determining forearm function in the pediatric population. This multicenter study involved 432 normal children under 15 years of age as controls. A retrospective analysis was conducted on anteroposterior and lateral radiographs from 58 children with Monteggia fractures after surgery. The correlation between the inner-epiphysis ulna-radius length ratio, postoperative Mayo elbow joint function score, and radiographic reduction quality of the brachioradial joint was analyzed. The mean inner-epiphysis ulna-radius length ratio was 1.094, with a standard deviation of 0.024. The maximum value ranged from 1.0336 to 1.168. The medical reference range, with a 95% confidence level, was calculated as 1.047 to 1.141. In children with Monteggia fractures, the postoperative inner-epiphysis ulna-radius length ratio showed significant correlations ( P  < 0.05) with postoperative imaging reduction quality, as well as the range of pronation, supination, flexion, and extension, and the Mayo elbow score. In normal children, the inner-epiphysis ulna-radius length ratio ranges from 1.0336 to 1.168, with a medical reference range of 1.047 to 1.141 at a 95% confidence level. Restoring this ratio (1.047–1.141) in children with Monteggia fractures can improve elbow function and radiographic radiocapitellar joint reduction quality.

The evaluation of epiphyseal areas by magnetic resonance imaging (MRI) for forensic age estimation is an important supportive diagnostic method to prevent repeated radiation exposure without a valid medical reason. There are still not enough individuals being analyzed with MRI for age estimation. The aim of this study was to investigate the utility of T1-weighted turbo spin echo (T1-TSE) MRI sequences in determining the degree of ossification of the distal femoral and proximal tibial epiphyses in a Turkish population. In this study, images from 649 patients (335 males and 314 females) aged 10–30 years were retrospectively evaluated with sagittal T1-weighted turbo spin echo (T1-TSE) MRI sequences of the knee. Proximal tibial and distal femoral epiphysis were scored by two different observers twice using the combined staging system described by Schmeling and Kellinghaus. Spearman’s rank correlation analysis indicated a significant positive relationship between age and ossification stages of the distal femoral and proximal tibial epiphyses (p < 0.001). The intra- and inter-observer reliabilities in evaluating the femur and tibia were separately determined and gave promising results and Cohen’s kappa statistics ranged from κ = 0.886 and κ = 0.961. The minimal ages of patients with stage 4 ossification were 15.1 years for females and 15.8 years for males for the distal tibial epiphysis and 15.4 years for females and 17 years for males for the distal femoral epiphysis. This study show that (T1-TSE) MRI and the applicability and Schmeling and Kellinghaus staging method of the knee can be performed for living 14- to 17-year-old individuals in need of a supportive noninvasive method for estimating forensic age.

Background This study aimed to evaluate the effect of using simultaneous double fluoroscopy, which provides anteroposterior (AP) and lateral images concurrently, on screw placement accuracy, surgical duration, and radiation exposure in the treatment of slipped capital femoral epiphysis (SCFE). Methods A retrospective study was conducted on 92 patients (73 males, 19 females; mean age 12.78 ± 1.54 years) who underwent in situ screw fixation for SCFE between 2017 and 2024. Patients were divided into two groups according to intraoperative imaging technique: single fluoroscopy (Group 1, n  = 44) and double fluoroscopy (Group 2, n  = 48). Demographic, operative, and radiographic parameters were compared between groups. Screw entry point and physeal fixation were graded in both AP and lateral planes. Results There were no significant differences in demographic or preoperative radiological parameters between groups ( p  > 0.05). The mean preparation time was less in Group 1 (9.68 ± 1.83 min) compared to Group 2 (17.38 ± 1.93 min, p  < 0.001). However, the surgical time was significantly longer in Group 1 (37.64 ± 10.68 min) compared to Group 2 (23.06 ± 6.45 min, p  < 0.001). The total operation time was extended in Group 1 (47.32 ± 10.92 min) than in Group 2 (40.44 ± 6.68 min, p  < 0.001). The mean fluoroscopy time was also longer in Group 1 (44.46 ± 9.15 s) than in Group 2 (39.73 ± 8.03 s, p  = 0.01). Radiographic analysis revealed superior screw positioning in the double fluoroscopy group, with significantly higher rates of optimal entry points in the lateral plane ( p  = 0.004) and improved physeal fixation in both AP ( p  = 0.036) and lateral ( p  = 0.019) planes. Complication rates were lower in Group 2 (2%) compared to Group 1 (9%). Conclusions Simultaneous double fluoroscopy during screw fixation of SCFE was associated with improved screw placement accuracy, reduced radiation exposure, and shorter total operative time, despite requiring slightly longer preparation. This method appears to be a reliable and effective technique that can enhance surgical precision and safety in hip surgery.

The timing of growth plate fusion is a key indicator for age estimation and is primarily used in forensic investigations. On the other hand, non-ionizing techniques such as MRI are being developed to provide safer and more ethical evaluations in forensic casework. This study aims to evaluate the closure process of growth plates in the distal femoral and proximal tibial epiphyses using Multiple Echo Recombined Gradient Echo (MERGE) MRI sequences and provide age estimation data based on staging methods for forensic purposes. We retrospectively analyzed 559 patients (294 males, 265 females, aged 8–25 years) diagnosed with trauma and knee pain at Tepecik Training and Research Hospital from 2016 to 2019. MRI scans were performed using a 1.5-T system with MERGE sequences and evaluated by two observers using a new staging system. Observer agreement was assessed using Cohen’s κ test, yielding high agreement values (κ > 0.8). Positive correlations were found between age and ossification stages ( p  < 0.001). Minimum age thresholds for stages 5a and 5b of the distal femoral epiphysis were 16 and 18 years for females and 17 and 19 years for males, respectively. For the proximal tibial epiphysis, the minimum ages for stages 5a and 5b were 15 years for females and 17 years for males. The MERGE sequence provides a viable method for assessing skeletal maturity in living individuals with significant ethical advantages due to non-ionizing radiation. This study supports the potential application of the MERGE sequence in forensic age estimation, demonstrating high observer agreement and consistency. Future research should focus on comparing different sequences and populations to enhance the methodology’s applicability.

Pituitary tumors account for about 15% of primary intracranial neoplasms. Proliferation of pituitary cells, which secrete hormones, may result in a spectrum of endocrine symptoms. Tumors that originate from pituitary somatotroph cells lead to aberrant secretion of growth hormone and the distinctive features of acromegaly. This review discusses advances in the understanding and treatment of acromegaly. Tumors that originate from pituitary somatotroph cells lead to aberrant secretion of growth hormone and the distinctive features of acromegaly. This review discusses advances in the understanding and treatment of acromegaly. Pituitary tumors account for about 15% of primary intracranial neoplasms. 1 Given the critical location of the gland, expanding tumors cause compressive symptoms. Furthermore, as pituitary cells secrete hormones, the proliferation of these cells may lead to a spectrum of endocrine symptoms. When tumors arise in pituitary somatotroph cells, aberrant secretion of growth hormone leads to the distinctive features of acromegaly. Understanding the development, function, and regulation of somatotroph cells provides insight into the cellular origin of this tumor, as well as approaches to the treatment of acromegaly. This review discusses advances in the understanding and treatment of acromegaly that have . . .