Nicholas F. Quercetti, DO, Steve DiStefano, BS, Michael Yayac, MD
et al.
Abstract. Objectives:. To describe a novel percutaneous technique utilizing a curved intramedullary implant for fixation of complex anterior pelvic ring fractures and to report preliminary clinical outcomes from a retrospective case series.
Design:. Retrospective case series.
Setting:. Single academic Level I trauma center.
Patients/Participants:. Nine female patients (mean age 74.8 years, range 53–89 years) with anterior pelvic ring injuries treated with percutaneous trans-symphyseal fixation using a curved intramedullary device between June 2023 and December 2024. All patients were treated by a single orthopaedic trauma surgeon and followed for a minimum of 6 months.
Intervention:. Percutaneous intramedullary fixation of the superior pubic ramus crossing the pubic symphysis and terminating in the contralateral ramus using a novel flexible, curved implant.
Main Outcome Measurements:. Operative time, estimated blood loss, implant complications, fracture union, and discharge disposition.
Results:. The novel technique was successfully performed in all 9 patients. Average total surgical time was 106.3 minutes, with a mean of 54.8 minutes dedicated to the anterior fixation. Average estimated blood loss was 132.2 mL. All fractures progressed to union with no cases of implant failure or surgical site infection. Assistive measures were required in 3 of 9 cases. Discharge disposition was favorable, with 5 of 9 patients discharged to home or acute rehabilitation. No complications related to the anterior implant were noted.
Conclusions:. This retrospective review suggests that trans-symphyseal curved intramedullary fixation is a feasible and safe technique for managing anterior pelvic ring fractures, including fragility and high-energy patterns. The method provides stable fixation while minimizing operative time, blood loss, and surgical exposure. Further studies are warranted to compare this technique against established modalities in larger cohorts.
Level of Evidence:. Level IV—Therapeutic study.
Carlo Ciccullo, Marco Grassi, Marco Antonio Carletti
et al.
<b>Background/Objectives</b>: Hospital-acquired and fracture-related infections remain major complications in orthopedic trauma surgery, with significant clinical and socio-economic impact. Antibacterial implant surface coatings represent a promising strategy to reduce early postoperative bacterial adhesion and biofilm formation. <b>Methods</b>: This retrospective matched case–control study evaluated the clinical effectiveness of an antibiotic-free fast-resorbable hyaluronic acid and poly-<span style="font-variant: small-caps;">d</span>, <span style="font-variant: small-caps;">l</span>-lactide hydrogel (DAC<sup>®</sup>) applied intraoperatively to orthopedic implants. A total of 222 patients with comorbidities who underwent open reduction and internal fixation between May 2023 and April 2024 in two trauma centers were included: 99 patients received the DAC<sup>®</sup> coating and 123 served as controls with standard fixation. The primary endpoint was infection incidence within 6 months; secondary endpoints included wound complications, revision surgery, prolonged antibiotic therapy, and bone healing. <b>Results</b>: Postoperative infection incidence was significantly lower in the DAC<sup>®</sup> group compared with controls (0.7% vs. 5.3%; <i>p</i> = 0.0363). Wound complications were also reduced (1.3% vs. 8.0%; <i>p</i> = 0.028), and only one patient in the DAC<sup>®</sup> cohort required additional surgical interventions or prolonged antibiotic therapy. Bone healing outcomes were comparable between groups, with no delayed unions reported in the treated cohort. <b>Conclusions</b>: Even if larger prospective studies with longer follow-up are required to further confirm these findings and better define long-term safety and effectiveness, the routine intraoperative use of DAC<sup>®</sup> hydrogel without antibiotic loading appears to be a safe and promising strategy to reduce early postoperative infections and wound complications in orthopedic trauma patients with comorbidities.
John M. Abrahams, Boopalan Ramasamy, Xiangyu Dong
et al.
Aims:
The aim of this study was to determine the early stability of acetabular components of total hip arthroplasty (THA) treating acute acetabular fractures through a replace-in-situ technique, using standard radiological assessment techniques as well as radiostereometric analysis (RSA), the gold standard for assessment of implant stability.
Methods:
We prospectively investigated 29 patients who underwent THA to manage an acute acetabular fracture in which patients underwent postoperative in-clinic radiological assessment of acetabular component stability, and detailed measurements using both RSA and manual techniques. The latter were performed based on pelvic reference landmarks located below and above the fracture. Greater than 3 mm of proximal translation and/or 5° of rotation around the sagittal axis were considered diagnostic of a loose acetabular component.
Results:
The median proximal translation and sagittal rotation of the cohort was 0.5 mm (IQR 0.3 to 0.9) and 0.8° (IQR -0.6° to 1.1°), respectively, as measured by RSA at two years. Acetabular components in the most unstable acetabular fracture patterns were found to migrate more immediately post-surgery. There was a disparity between different measurement techniques. Accurate RSA measurements correctly identified two components that were deemed to be clinically loose, and the diagnostic performance of RSA migration measurements was improved when migration within the first six months was excluded. Visual assessment of radiographs in clinic underestimated – and manual radiological measurements overestimated – acetabular component loosening in these complex cases.
Conclusion:
The replace-in-situ technique led to acceptable early acetabular component stability in the majority of cases (27/29, 93%), a good result considering the complexity of these reconstructions. Accurate measurements of acetabular component migration are recommended in these cases, as pelvic landmark identification on consecutive plain radiographs is influenced by both pelvic projection on plain radiographs and fracture fragment migration during healing.
Cite this article: Bone Jt Open 2025;6(10):1282–1294.
K T Rajashekhar, Kartik Mangsuli, Adarsh Krishna K Bhat
Introduction:
Femoral condyle osteonecrosis of the knee leading to osteoarthritis is a rare entity, which is noticed more commonly in elderly women. Usually, the medial condyle is involved; lateral condyle involvement is extremely rare. Cases like these with occurrence in young individuals are even more rare and need thorough pre-operative evaluation, patient counseling, and intraoperative correlation for proper line of management. Based on the size and stage of the lesion, treatment options vary from medical management to biological therapies to arthroplasty in advanced cases.
Case Report:
A 17-year-old male with a body mass index of 29.6 presented to our outpatient clinic with complaints of pain over the left knee, difficulty in walking, squatting, and sitting cross-legged. He was examined clinically, radiologically, and intraoperatively based on the findings and was diagnosed with osteonecrosis of the lateral femoral condyle femur extending into the trochlea with arthritic changes. After detailed discussion and counseling with the patient and relatives, keeping in mind the patient’s demand and expectations, he underwent robotic-assisted total knee arthroplasty (TKA).
Discussion:
Knee osteonecrosis is a debilitating, progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only management option is TKA.
Conclusion:
Osteonecrosis of the knee in young patients, particularly when there is extensive articular involvement and associated osteoarthritic changes, is quite challenging to treat. Although joint preservation is typically preferred in younger individuals, TKA may be the only viable option in advanced stages to restore function and quality of life. Robotic-assisted TKA allows for precise implant positioning and optimal alignment and thus enhances the functional outcome. Individualized treatment planning, thorough pre-operative evaluation, and comprehensive patient counseling are essential to achieving successful outcomes in such rare and complex cases.
Orthopedic surgery, Diseases of the musculoskeletal system
Brachial plexus paralysis is a rare but serious complication following clavicle fractures that is often linked to neurovascular compression, with an incidence of 0.5% to 9.0%. This report presents a case of brachial plexus paralysis in a 61-year-old woman after surgical fixation of a deformed mid-clavicle fracture with a metal plate. Revision surgery was performed to address the paralysis, involving removal of the metal plate, arcuate osteoplasty to create a smooth arch beneath the clavicle, and re-fixation of the plate with adjusted superior angularity. We used this approach to relieve neurovascular compression and restore thoracic outlet space. Over a period of 1 year, significant recovery and successful fracture union were achieved. This case demonstrates that managing brachial plexus paralysis with revision surgery and osteoplasty can effectively restore both neurological function and bone healing.
Background:
Spinal fusion surgery is estimated to be among the top 10 procedures associated with blood transfusion. However, blood transfusion may lead to several complications. Therefore, identifying patients at risk of blood transfusion in primary lumbar fusion surgery is crucial.
Objectives:
To investigate the predictors for blood transfusion in patients with primary lumbar fusion surgery.
Materials and Methods:
All patients who underwent primary lumbar fusion surgery for degenerative spine diseases, excluding those who had emergency surgery, revision surgery, pathological or infectious conditions, or procedures involving other regions of the spine, were enrolled in this retrospective study from January 2020 to December 2023. Descriptive statistics are reported as frequencies (percentages) or as mean and standard deviation. Categorical variables were compared using the Chi-square test or Fisher’s exact test, while continuous variables were assessed using independent-sample t-tests. Multivariate logistic regression analysis was performed to identify the significant predictors for blood transfusion. A nomogram was established to individually estimate the probability of blood transfusion.
Results:
Three hundred and seventy-seven patients were enrolled in this study and 62 (16.45%) had blood transfusions. Statistical analyses revealed that preoperative hemoglobin (Hb) level (odds ratio [OR] = 0.441), operative time (OR = 2.61), the levels of fusion (OR = 6.23), American Society of Anesthesiologist class (ASA) (OR = 2.95) and the procedure type (OR = 0.222) were significant predictors. The area under the ROC curve (AUC) of nomogram model was 0.9179 (P < 0.001).
Conclusions:
Low preoperative Hb level, longer operative time, the levels of fusion ≥ 2, and ASA class ≥ 3, and the procedure type were significant predictors of blood transfusion in primary lumbar fusion surgery. Our nomogram can contribute to clinicians predicting whether patients will likely require a blood transfusion during the perioperative phase.
Ludovica Golino, Michela Saracco, Marco Caiazzo
et al.
Major trauma is bound to be managed in highly specialized centers. Due to logistics needs or due to an initial clinical stabilization, these patients happen to be managed in hospitals that are not fully equipped for trauma. We handled a patient, major trauma to dynamics following a high-speed collision between two cars in which she was behind the wheel. The patient was also complex due to cardiovascular and respiratory comorbidities. After ‘ABCDE’ and radiological evaluation, the patient was managed in our hospital with ICU recovery and multiple orthopedic interventions to which she was subjected with neuraxial and peripheral regional anesthesia. The patient was managed successfully and with excellent pain control. The risks associated with her comorbidities were limited to a minimum and she was discharged for rehabilitation 5 days after the operations.
Medical emergencies. Critical care. Intensive care. First aid, Anesthesiology
Treatment of large bone defects represents a great challenge in orthopedic and craniomaxillofacial surgery. Although there are several methods for bone reconstruction, they all have specific indications and limitations. The concept of using barrier membranes for restoration of bone defects has been developed in an effort to simplify their treatment by offering a sinlge-staged procedure. Research on this field of bone regeneration is ongoing, with evidence being mainly attained from preclinical studies. The purpose of this review is to summarize the current experimental and clinical evidence on the use of barrier membranes for restoration of bone defects in maxillofacial and orthopedic surgery. Although there are a few promising preliminary human studies, before clinical applications can be recommended, future research should aim to establish the 'ideal' barrier membrane and delineate the need for additional bone grafting materials aiming to 'mimic' or even accelerate the normal process of bone formation. Reproducible results and long-term observations with barrier membranes in animal studies, and particularly in large animal models, are required as well as well-designed clinical studies to evaluate their safety, efficacy and cost-effectiveness.
BACKGROUND No study has yet assessed the efficacy of virtual reality (VR) simulation for teaching orthopedic surgery residents. In this blinded, randomized, and controlled trial, we asked if the use of VR simulation improved postgraduate year (PGY)-1 orthopedic residents' performance in cadaver total hip arthroplasty and if the use of VR simulation had a preferentially beneficial effect on specific aspects of surgical skills or knowledge. METHODS Fourteen PGY-1 orthopedic residents completed a written pretest and a single cadaver total hip arthroplasty (THA) to establish baseline levels of knowledge and surgical ability before 7 were randomized to VR-THA simulation. All participants then completed a second cadaver THA and retook the test to assess for score improvements. The primary outcomes were improvement in test and cadaver THA scores. RESULTS There was no significant difference in the improvement in test scores between the VR and control groups (P = .078). In multivariate regression analysis, the VR cohort demonstrated a significant improvement in overall cadaver THA scores (P = .048). The VR cohort demonstrated greater improvement in each specific score category compared with the control group, but this trend was only statistically significant for technical performance (P = .009). CONCLUSIONS VR-simulation improves PGY-1 resident surgical skills but has no significant effect on medical knowledge. The most significant improvement was seen in technical skills. We anticipate that VR simulation will become an indispensable part of orthopedic surgical education, but further study is needed to determine how best to use VR simulation within a comprehensive curriculum. LEVEL OF EVIDENCE Level 1.
Abstract
Between April 1990 and December 1993, fourteen patients with cervical injury underwent corpectomy, grafting and internal fixation with AO/ASIF plate in the same session, at the 1 st Clinic of Orthopaedics and Traumatology and 1st Clinic of Neurosurgery in Ankara Numune Hospital. 6 of these cases had been operated for grafting by Cloward technique and the grafts were then dislocated. In 5 others the spinal axis were distorded and they all showed instability and neurologic compromise. One patient had been operated for three Ievellaminectomy, another one was quadriplegic and showed wide skin Iesions due to the Halo-vest. In the Iast patient the injury was unstable and emergent. Crutchfield traction was routine for all patients preoperatively. On the second postoperative day they were mobilized according to the neurologic status. A cervical colIar was used for 2 months. One patient died on the 1Oth postoperative day and infection was developed in one patient. On the follow up (ranging 1 month to 2.5 years) no additional neurologic deficit was developed. In 9 patients neurologic status was significantly improved. We did not find any problems related to fusion or stability. As for the result of this study; in cervical vertebrae injuries, anterior decompression, bone grafting and AO/ASIF plating is a safe and effective method. The increasing sympathy for internal fixation through anterior approach versus this method decrease the postoperative immobilization period, makes the Iife easier and shortens the time for complete fusion.
Özet
Nisan 1990-Aralık 1993 tarihleri arasında Ankara Numune Hastanesi 1. Ortopedi ve Travmatoloji ve 1. Nöroşirürji Kliniklerinde 14 servikal yaralanmalı hastaya, aynı seansta anteriordan korpektomi, greft ve AO/ASIF plak uygulanmıştır. Olgulardan 6 sına daha önceden Cloward tekniği ile greft uygulanmış ve disloke olmuştu, 5 olguda spinal aks bozulmuş, instabilite ve nörolojik defisit mevcuttu, 1 olguya 3 seviyeli Iaminektomi uygulanmış, 1 olgu quadriplejik olup halo vest e bağlt geniş cilt Iezyonları vardı, 1 olguda ise anstabil ve acildi. Tüm olgulara preoperatif Crutchrield traksiyon uygulandı. Postoperatif ikinci gün nörolojik durumlarına göre mobilize edildiler. 2 ay servikal yakalık kullanıldı. postoperatif bir olgu 10. gün exitus oldu. 1 olguda enfeksiyon gelişti. Takipte ilave nörolojik defisit gelişmedi, 9 olguda nörolojik bulgular anlamlı oranda düzeldi. Hiç bir olguda füzyona ve stabiliteye ait problem gelişmedi. Bu çalışmadan elde edilen sonuç; servikal vertebra yaralanmalarında, anterior dekompresyon, kemik greftlemesi ve AO/ASIF servikal plak-vida uygulamasının güvenilir ve etkili bir metod olduğudur. Anterior yaklaşımla internal fiksasyona artan güven, son senelerde posteriora karşı anterior yaklaşımın daha çok kullanımı ile de anlaşılmaktadır. Y֮tem postoperatif immobilizasyonu azaltabilecek, hastaya kolay bir yaşam sağlayabilecek, füzyon süresini kısaltacak derecede etkili bir yöntemdir.
Erkal Bilgiç, Orhan Balta, Mehmet Burtaç Eren
et al.
Predictive scoring systems are designed to predict patients' discharge status, patient mortality, Intensive Care Unit(ICU) mortality and lenght of hospital stay. These scoring systems, which are aimed to standardize and form a common language in terms of evaluating patient general health situation, are used in the evaluation of patients in many ICU.In this study, we aimed to evaluate the ability of the scoring systems that can be used to predict the mortality of the patients who will be followed up in the ICU after orthopedic surgery and predict the mortality that occurs in the first year outside the hospital.
We established our hypothesis that there will be no difference between the predictive power of predictive scoring systems, which can be used as a marker of mortality, since relatively short-term hospitalizations occur in the ICU after orthopedic surgery.
Our study was designed as a single center retrospective.
Between January 2017 and August 2018, all patients undergoing level 3 intensive care follow-up were identified in the automation system. After the evaluation of 146 patients' files and automation system data, patients who were in compliance with the inclusion and exclusion criteria were identified.
A total of 40 patients were included in the study. The mean age was 75.69 (SD = 8.66 years), 50% male and 50% female. Fifteen patients (37.5%) died during their first year follow-up.
When the patients were evaluated as survivors and non-survivors in the first year, it was observed that there was a significant difference between the groups in terms of quantitative variables in terms of early postoperative GCS and in terms of early postoperative oxygen saturationThere was no significant difference between the two groups in terms of qualitative variables. (P gt; 0.005)
An appropriate mortality predictor score should be selected to standardize follow-up in intensive care unit.
As a result of our study, there was no significant relationship between gropus SOFA, qSOFA scores and SIRS critera met suggested that these scoring systems were not suitable for predicting 1-year mortality in our patient group.
We believe that specific criteria should be established with studies with larger series and more criteria.
Yusuf Ozturkmen, Cemal Dogrul, Mehmet B. Balioglu
et al.
Abstract
Objectives: We evaluated the results of intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails.\nMethods: Twenty six children (19 boys, 7 girls, mean age 8.9 years, range 5.9 to 12.3 years) were stabilized with flexible intramedullary Ender nails placed by the retrograde technique. Nineteen were isolated femoral fractures. The fractures occurred in the middle third (n=18), distal third (n=5), and proximal third (n=3) of the femur. The mean follow-up was 22.3 months (range 8 to 47 months). Radiologically, anteroposterior and lateral radiographs were evaluated. To determine leg length discrepancy, 25 children had scanograms beyond 12 months. Clinically, the level of the hip and knee motion and walking patterns were evaluated.\nResults: Union was achieved in all patients within a mean of 6.6 weeks (range 5 to 12 weeks). Twenty four fractures healed with a normal anteroposterior alignment while two children had 5° varus and 7° valgus, respectively. Lateral radiographs showed an anterior angulation of 7° and a posterior angulation of 6° in two patients, respectively. The femur length remained equal to that of the contralateral side in 19 patients (76%), whereas it exceeded by a mean of 7 mm in four, and shortened by a mean of 6 mm in two children. All patients but one had a symmetric walking pattern. All children but one had a normal range of hip and knee motion. No instances were observed concerning delayed union, infection, nonunion, rod fractures, growth arrest, injury to the femoral epiphysis, or refractures after rod removal.\nConclusion: Intramedullary nailing with the use of elastic Ender nails provided effective fixation in the treatment of femoral shaft fractures in children 6 to 12 years of age.
Özet
Amaç: Çocuk femur diafiz kırıklarının elastik Ender çivileriyle intramedüller cerrahi stabilizasyonunun sonuçları değerlendirildi.\nÇalışma planı: Yirmi altı çocuktaki (19 erkek, 7 kız; ort. yaş 8.9; dağılım 5.9–12.3) femur diafiz kırığına retrograt olarak fleksibl Ender çivileri ile osteosentez yapıldı. On dokuz olguda izole femur diafiz kırıkları bulunurken, diğer olgular politravmatize idi. Kırık femur, üç olguda 1/3 proksimalde, beş olguda 1/3 distalde, 18 olguda 1/3 ortada idi. Ortalama 22.3 ay (dağılım 8-47 ay) izlenen olguların radyolojik değerlendirmesi ön-arka ve yan grafilerle yapıldı. Takip süresi bir yılın üzerinde olan 25 olguda, ortoröntgenografi ile ektremite boyları ölçüldü. Klinik olarak kalça ve diz hareketleri, yürüme şekilleri değerlendirildi.\nSonuçlar: Olguların hepsinde ortalama 6.6 haftada (dağılım 5-12 hafta) kaynama sağlandı. Yirmi dört olgu, radyolojik olarak ön-arka grafilere göre normal aksında iyileşirken, bir olgu 5° varus, bir olgu 7° valgusta iyileşti. Yan grafilere göre, bir olguda 7° öne, bir olguda 6° arkaya angulasyon vardı. On dokuz olguda (%76) femur, karşı taraf femuru ile eşit uzunlukta iken, dördünde (%16) ortalama 7 mm uzunluk, ikisinde (%8) ortalama 6 mm kısalık saptandı. Biri dışında bütün olgular simetrik adım atıyordu. Biri dışında hepsinde kalça ve diz hareket aralığı tam idi. Olguların hiçbirinde kaynama gecikmesi, enfeksiyon, kaynamama, çivi kırılması gözlenmedi. Hiçbir olguda büyüme potansiyelinin durması veya femur epifizlerinde hasar saptanmadı. Çivi çıkarılan olguların hiçbirinde kırık tekrarlamadı.\nÇıkarımlar: Elastik Ender çivileri ile intramedüller çivileme 6-12 yaş arası çocuklarda femur diafiz kırıklarının tedavisinde etkili bir fiksasyon yöntemidir.
Eugene S Krauss,1– 4 Ayal Segal,1,4 Debra Schulman,1,4 Nancy Dengler,1 Thomas Bily,1 MaryAnne Cronin,1 Kathleen Altner4 1Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY, USA; 2Krauss Musculoskeletal Institute, Peconic Bay Medical Center, Affiliate of Northwell Health, Riverhead, NY, USA; 3Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA; 4New York Orthopaedic and Spine Center, Great Neck, NY, USACorrespondence: MaryAnne CroninSyosset Hospital, Northwell Health, 221 Jericho Turnpike, Syosset, NY 11791, USAEmail mcronin@northwell.eduAbstract: On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption of urgent elective procedures, this hospital became one of the two designated sites within the Northwell Health system to be “non-COVID.” Once the hospital was emptied of all inpatients, a complete and thorough cleaning and disinfection was performed on the entire building. All equipment was thoroughly decontaminated following Centers for Disease Control and Prevention (CDC) guidelines. In anticipation of the resumption of elective surgery, each surgeon evaluated their cancelled case list to determine patient priority, based on a scale of 1 (elective, non-urgent), 2 (semi-urgent), 3 (urgent), to 4 (highly urgent). Site-specific disaster credentialing was expedited so that emergent surgeries could be performed by surgeons located at other Northwell sites. To ensure a structured and informative onboarding process, each visiting surgeon received a “welcome” email which requested pertinent information to facilitate the surgical process. Presurgical, surgical, and postoperative protocols were revised based on federal and local guidance and regulations. Resumption of elective surgery post COVID-19 placed the hospital into uncharted territory.Keywords: COVID-19, elective surgery, orthopedic surgery, total joint arthroplasty, pandemic
Orthopedic surgery, Diseases of the musculoskeletal system
Background:. The management of slipped capital femoral epiphysis (SCFE) is controversial. Surgical decision-making is based regularly on the chronicity, stability, and severity of the slip. The purpose of this study was to determine the true angulation and spatial orientation of the epiphysis in hips with SCFE and contralateral hips.
Methods:. Eighteen hips in 18 patients with SCFE were included in the analysis. Trigonometric calculations, based on angle measurements using 2 conventional radiographs in planes that are perpendicular to each other, were used to determine the angulation of the epiphysis and its orientation in space.
Results:. The mean absolute epiphyseal obliquity of the SCFE hips was 56.2° and the spatial orientation was 36.5°. The mean obliquity of the contralateral side was 34.0°, with a related spatial orientation of 16.8°. The maximum error can reach up to 9.9° (or 41%) when comparing the calculated angles with the angle measurements on radiographs.
Conclusions:. On standard radiographs, the epiphyseal angulation in SCFE is consistently underestimated. As a consequence, the assigned classification of some patients may be 1 severity group too low, which impacts the value of traditional severity classification for surgical decision-making. The analysis of the spatial orientation of the slip with the concomitant direction of the resultant shear can partially explain varus and valgus slip in SCFE.
Level of Evidence:. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.