Prophylactic Pinning in Slipped Upper Femoral Epiphysis – a Closed Loop Audit of 25 Years Practice

Description

In this presentation, Jamie MacLean discusses the controversial topic of prophylactic pinning of the contralateral hip in cases of unilateral upper femoral epiphysis slips, particularly in the absence of endocrinopathy. The talk outlines varying practices among different countries, underscoring that only a minority opt for universal pinning, while the majority maintain a selective approach. MacLean presents findings from a 2005 study involving 60 patients and observes significant subsequent slips in unilateral cases, highlighting morbidity concerns linked to pinning procedures, including infection and complications like AVN.



The presentation transitions to a protocol introduced in 2005 for universal prophylactic pinning, revealing demographic and complication details from two distinct patient cohorts. The discussion acknowledges that while subsequent slip rates remained consistent with earlier studies, complications were minimal in the prophylactic pinning cohort.



The conversation with Roger Walton further dives into technical aspects of surgical procedures, questioning the effectiveness of growing screws in younger patients and the challenges of maintaining appropriate pin trajectory during surgery. The dialogue reflects on the importance of long-term follow-up and auditing outcomes to assess the efficacy and safety of prophylactic pinning interventions, while also acknowledging differing patient demographics that may influence results.

DOI: 10.1302/3114-221532

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