Le traitement des épiphysiolyses par vissage in situ, vise à éviter l’aggravation du glissement métaphyso-épiphysaire de l’extrémité proximale du fémur. Une mise en décharge postopératoire est classiquement proposée, mais sa durée ne correspond généralement pas à l’obtention d’une épiphysiodèse solide. Le but de cette étude est de déterminer si la mise en charge des épiphysiolyses chroniques ou stables après vissage unique percutané peut entraîner une majoration secondaire du déplacement. Trente épiphysiolyses chez 25 patients ont été analysées. Pour dix enfants, un appui postopératoire immédiat a été autorisé. Tous les patients ont été revus à 1 mois, 3 mois, 6 mois, et 1 an. Le déplacement a été mesuré au moyen de l’angle cervico-épiphysaire. Aucune aggravation du glissement n’a été mesurée sur les contrôles radiographiques à distance.

The purpose of this study was to ascertain whether immediate weight bearing after surgery for chronic or stable epiphysiolysis treated with a single percutaneous screw increases the risk of greater displacement.

Epiphysiolysis procedures (n=30) performed in 25 patients were reviewed retrospectively. One percutaneous screw was inserted under fluoroscopic control in all cases. For ten patients (from 2002), weight bearing was allowed immediately after surgery. The Southwick grading system was applied to classify each epiphysiolysis into one of three stages according to the cervicoepiphyseal angle measured on the lateral radiograph. Clinical and radiographic controls were obtained in all children at 1, 3, 6, and 12 months. Outcome was assessed using the Heyman and Herndon criteria.

The study population included 17 boys and 8 girls (mean age 12 years 18 months). The left side was involved in 12, the right in 8 and both in 5. Weight bearing was allowed immediately after surgery in 10 patients with a stable epiphysiolysis (4 stage I, 5 stage II, 2 stage III). Time to weight bearing was 3 months on average for the others. Mean follow-up was 4 years (range 1-8 years). Clinically, none of the ten patients presented pain or limping at last follow-up. Abduction was limiting in 9 and internal rotation in 19. There was no increase in the displacement for patients with immediate weight bearing.

Most teams advise against weight bearing for 6 weeks to 3 months. We were unable to find any pathophysiological reason for this attitude. It would be more logical to wait until complete fusion of the subcapital growth cartilage before authorizing weight bearing. This raises the question of the effect of this practice on postoperative displacement For stable epiphysiolysis, there is no evidence that not allowing weight bearing had an effect on the evolution if the screw is correctly positioned and at least 4 or 5 spires are engaged within the epiphysis.