ReviewJournal of the Pediatric Orthopaedic Society of North America2026
Failure Modes of Screw Fixation in Slipped Capital Femoral Epiphysis: A Proposed Life-Cycle Classification.
Review in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Screw fixation is the standard surgical treatment for slipped capital femoral epiphysis. Screw-related adverse events, including implant breakage, joint penetration, fixation failure, growth-mediated construct change, removal failure, and postremoval fracture, are inconsistently reported throughout the pediatric orthopaedic literature. In this current concept review, we propose a practical, life-cycle classification encompassing implant insertion, in vivo fixation, growth and remodeling, implant removal, and postremoval follow-up. Reported screw-related failures cluster into four practical evidence domains: placement-related risk, construct-longevity failure, mechanical implant failure, and removal/postremoval complications. These domains are organized into seven chronological life-cycle categories. A four-domain synthesis mapped to a seven-stage life-cycle classification provides a practical framework and shared vocabulary for preoperative counseling, implant selection, postoperative surveillance, removal planning, and standardized reporting. Key Concepts: (1)Screw-related failures after pediatric proximal femoral fixation are heterogeneous and can occur at any point in the implant life cycle, from insertion through long-term postremoval follow-up.(2)Reported failures can be grouped into four practical evidence domains: placement-related risk, construct-longevity failure, mechanical implant failure, and removal/postremoval complications, which map to seven chronological life-cycle categories.(3)Construct-level decisions, including single- versus two-screw fixation, screw-thread configuration, and implant material, entail different trade-offs across the insertion, fixation, growth, and removal stages.(4)Because pediatric proximal femoral fixation is performed in a growing skeleton, the relationship among the screw, physis, epiphysis, and femoral neck may change over time, warranting continued surveillance even after technically successful fixation.(5)Implant removal is a distinct failure window; removal-related and postremoval complications should be anticipated during preoperative counseling rather than assumed to be benign.
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