A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-08-01 DOI:10.1177/18632521231177272
Doğaç Karagüven, Pervin Demir, Selcen Yüksel, Hakan Ömeroğlu
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Abstract

Purpose: The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side.

Methods: In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children.

Results: In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age.

Conclusions: The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances.

Level of evidence: level V.

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一项德尔福共识研究治疗股骨骨骺滑动:在轻度和中度滑动中有相当多的共识,在严重滑动中有有限的共识。
目的:本专家共识研究的目的是就不同类型股骨骨骺滑动的治疗和对侧未受影响侧预防性螺钉固定的使用达成共识。方法:本研究采用四轮德尔菲法。问卷包括所有可能的理论滑移情况,在线发送给14名参与者,他们在儿童骨科领域和儿童髋关节疾病的治疗方面经验丰富。结果:在所有类型的轻度滑移和中度、稳定滑移情况下,原位固定被认为是首选的治疗方法。在中度、不稳定和所有严重滑移情况下,不赞成进行原位固定。在中度至重度、不稳定的滑移情况下,使用温和的闭合或开放复位和内固定是一致的。对于严重、稳定滑移的最佳治疗方法尚无共识。对于同时存在内分泌紊乱和年龄较小的情况下,对侧预防性螺钉固定的使用也有共识。结论:即使在经验丰富的外科医生中,对所有类型的股骨头骨骺滑动的治疗方法建立共识似乎也是不可能的。滑移的严重程度和滑移的稳定性分别是外科医生治疗选择的主要和次要决定因素。原位固定仍然是几种滑移类型的首选治疗方案。在移位的、不稳定的卡瓦中,建议采用关闭或打开的方法进行温和的资本调整。对侧预防性螺钉固定在某些情况下是可行的。证据等级:V级。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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