Evaluation of Skeletal Maturity for Slipped Capital Femoral Epiphysis
| Status: | Completed |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 8 - 16 |
| Updated: | 4/2/2016 |
| Start Date: | October 2008 |
| End Date: | December 2015 |
| Contact: | Tamir Bloom, MD |
| Email: | bloomta@umdnj.edu |
| Phone: | 973-972-0246 |
Skeletal Age Assessment From the Olecranon For Slipped Capital Femoral Epiphysis
This study is being done for two reasons: 1) to evaluate growth problems in the hip in
patients with Slipped Capital Femoral Epiphysis (SCFE) as they continue to grow into adults,
and 2) to help doctors determine which patients are at risk for developing a SCFE on their
opposite hip. Studies show that up to 60% of patients with a SCFE will go on to develop a
SCFE on their other side. Being able to better determine which patients are at risk for
developing a SCFE on the other side will help physicians better monitor patients with a
history of a SCFE and perhaps treat them before they develop a SCFE on the opposite side. By
studying the growth centers seen on X-rays of your child's legs and elbow, the investigators
may be able to better predict which children with a SCFE are at risk for developing a SCFE
on their opposite hip and potential growth problems as they continue to grow.
patients with Slipped Capital Femoral Epiphysis (SCFE) as they continue to grow into adults,
and 2) to help doctors determine which patients are at risk for developing a SCFE on their
opposite hip. Studies show that up to 60% of patients with a SCFE will go on to develop a
SCFE on their other side. Being able to better determine which patients are at risk for
developing a SCFE on the other side will help physicians better monitor patients with a
history of a SCFE and perhaps treat them before they develop a SCFE on the opposite side. By
studying the growth centers seen on X-rays of your child's legs and elbow, the investigators
may be able to better predict which children with a SCFE are at risk for developing a SCFE
on their opposite hip and potential growth problems as they continue to grow.
After obtaining informed consent, pediatric patients presenting to our institution with a
SCFE will have a single radiograph of the elbow, in addition to those radiographs currently
obtained as part of routine evaluation and treatment (e.g. AP pelvis, bilateral hip
laterals, scanogram, and hand bone age). This additional radiograph, a single one-time
lateral elbow radiograph taken on initial presentation with a SCFE, will be used to assess
bone age and compared with other radiographic methods, i.e. hand bone age, currently used to
assess skeletal maturity. Scanogram of the lower extremities, at initial presentation and at
the completion of skeletal growth, will be used to accurately assess the length of the lower
extremities and evaluate limb length discrepancy at maturity. Treatment of the patient's
SCFE and post-operative management will be as per routine care at our institution. Patients
will be followed until skeletal maturity.
The medical records and radiographs of patients with SCFE will be collected. Patient data
will include:
- Patient demographics- chronologic age, gender, race/ethnicity, standing height, weight,
BMI, clinical follow-up duration
- SCFE type- chronicity of symptoms prior to presentation, Loder classification of slip
stability, laterality, time between sequential SCFEs
- Skeletal maturity data- bone age, triradiate closure, Risser sign, modified Oxford bone
age, olecanon method and the Simplified skeletal maturity scoring system
- Radiographic data- slip severity, physeal slope angle, and leg length discrepancy
- Complications
- Additional procedures
In order to compare the various radiographic methods of skeletal age assessment, the elbow
hand and AP pelvis radiographs will be reviewed once by three independent and experienced
observers, two pediatric orthopaedic surgeons and one musculoskeletal radiology attending.
The radiographic skeletal age assessment will be discussed by these three observers in order
to minimize intraobserver and interobserver errors.
SCFE will have a single radiograph of the elbow, in addition to those radiographs currently
obtained as part of routine evaluation and treatment (e.g. AP pelvis, bilateral hip
laterals, scanogram, and hand bone age). This additional radiograph, a single one-time
lateral elbow radiograph taken on initial presentation with a SCFE, will be used to assess
bone age and compared with other radiographic methods, i.e. hand bone age, currently used to
assess skeletal maturity. Scanogram of the lower extremities, at initial presentation and at
the completion of skeletal growth, will be used to accurately assess the length of the lower
extremities and evaluate limb length discrepancy at maturity. Treatment of the patient's
SCFE and post-operative management will be as per routine care at our institution. Patients
will be followed until skeletal maturity.
The medical records and radiographs of patients with SCFE will be collected. Patient data
will include:
- Patient demographics- chronologic age, gender, race/ethnicity, standing height, weight,
BMI, clinical follow-up duration
- SCFE type- chronicity of symptoms prior to presentation, Loder classification of slip
stability, laterality, time between sequential SCFEs
- Skeletal maturity data- bone age, triradiate closure, Risser sign, modified Oxford bone
age, olecanon method and the Simplified skeletal maturity scoring system
- Radiographic data- slip severity, physeal slope angle, and leg length discrepancy
- Complications
- Additional procedures
In order to compare the various radiographic methods of skeletal age assessment, the elbow
hand and AP pelvis radiographs will be reviewed once by three independent and experienced
observers, two pediatric orthopaedic surgeons and one musculoskeletal radiology attending.
The radiographic skeletal age assessment will be discussed by these three observers in order
to minimize intraobserver and interobserver errors.
Inclusion Criteria:
- Slipped capital femoral epiphysis
Exclusion Criteria:
- Prior Slipped capital femoral epiphysis not initially treated at our institution
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