107.
Slipped Capital Femoral Epiphysis - a case file study in the Danish
Patient Insurance Association
Mathilde Pihl, Stig Sonne-Holm, Jens Krogh Christoffersen, Christian Wong
Pediatric Orthopeadic Surgery Hvidovre University Hosital; Pediatric
Orthopeadic Surgury, Hvidovre University Hospital; The Danish Patient
Insurance Association, ; Pediatric Orthopeadic Surgury, Hvidovre University
Hospital
Background:
Slipped Capital Femoral Epiphysis (SCFE) is the most common
hip disorder in adolescents. Primary treatment is acute epiphysiodesis, since
delayed treatment may initiate destruction of the hip. The Patient Insurance
Association (DPIA) receives requests for compensation due to damage from
potential maltreatment or misdiagnosis.
Purpose / Aim of Study:
To find causalities or similarities in cases of SCFE
in order to understand the background for the complaints and the potential
effect on treatment.
Materials and Methods:
A screening of the DPIA case files from the period
1996
to 2011 was done (diagnose code DM930). A total of 44 SCFE cases
were extracted, but 2 cases were excluded since hip disease originated from
other disorders.
Findings / Results:
The mean age of the patients was 12.4 years. Only one
case of SCFE was traumatic induced. Doctors delay because of misdiagnosis
was on average 4.5 months in 27 cases. The correct diagnosis was set in 25
cases. The following complications was found in 16 case files: 4 avascular
necrosis, 1 fracture, 9 cases of ongoing pain and 4 deformations impairing
movement. The doctor responsible was a GP in 7 cases, a resident in 20 cases,
a trained orthopaedic surgeon in 13. In 5 cases complaints were about
treatment in hospitals now highly specialized in treating SCFE, the remaining
due to treatment at other hospitals. In 16 cases the DPIA categorized the
outcome as ‘severe disability’, and 22 patients got economic compensation.
Conclusions:
The doctors delay might affect the outcome of treatment and
seems to be the reason for many of the complaints to the DPIA. Competence
level of the hospitals and doctors in these selected cases could have an impact
on the treatment as well. By further studying these aspects of SCFE treatment
we might be able to enhance treatment outcome.
