Children’s orthopaedic surgeons at Royal Berkshire Hospital perform a growing telescopic hip screw operation in Reading, to treat a 9 year old boy with slipped upper femoral epiphysis. (SUFE)
SUFE is a children’s hip condition that usually affects children around the age of 13 years.
(See Pictures 1a and 1b)
Pictures 1a and 1b Frog lateral X-Ray showing SUFE of left hip - *B should be at *A
It can present with non-specific pain in the affected leg (groin, thigh or knee and is often accompanied by a limp) Diagnosis can sometimes be delayed but loss of internal rotation, compared to the other side, is a key examination finding. (See Picture 2)
Picture 2 showing the internal rotation examination of a child’s hip
Traditional treatment for mild to moderate slips involves fixing the epiphysis with a screw across the growth plate (physis) to prevent further slip and promote early fusion of that physis.
In a younger child, who presents with this condition, prematurely closing the physis can cause a significant leg length discrepancy, so the idea of a sliding, telescopic, growing screw, that elongates as the child grows, is very attractive.
Pega Medical Inc. (www.pegamedical.com) an innovative medical devices company have developed such a ‘Free Gliding screw’ which we successfully used. (see Pictures 3a & 3b) It has a male and female component that slide freely telescope inside each other.
Picture 3a & 3b – Telescopic growing screw – at the start and then elongated.
The sizes and lengths are measured and calculated preoperatively and intraoperatively. (See Pictures 4a and 4b.) The fixation of the female component is into the epiphysis, the fixation of the male component is into the anterior cortex of the neck of the proximal femur. (See Pictures 5a and 5b)
Pictures 4 a (AP projection) and 4 b (lateral projection) – intraoperative fluoroscopy showing precision x-ray guided insertion of guide wire into the epiphysis perpendicular to the physis at its midpoint.
Many thanks to the team at Strawberry Medical Ltd who are the UK company who supply the implants and kit to enable us to do this cutting edge surgery.
Pictures 5a and 5b – AP and lateral fluoroscopy views showing growing screw in situ – 48mm by 6.5mm.
Nev Davies and Amr ElKhouly are Specialist Children’s Trauma and Orthopaedic Surgeons working in Reading.
They are passionate about teaching and education. If you are a physio or GP and would like Nev or Amr to come to your practice or clinic and talk to you about anything related to Children’s Trauma and Orthopaedics please contact us below.
If you are a patient or parent you can arrange to see Nev, Amr or one of the team on the NHS via your GP referral to the CAT 5 Team at Royal Berkshire Hospital. If you would like to see Nev privately please contact his secretary Debbie Rollason on firstname.lastname@example.org