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Evaluation of the Southwick Angle in Two Hundred Hips of Asymptomatic Children and Adolescents[*]Article in several languages: português | English
11 October 2018
26 March 2019
23 March 2020 (online)
Objectives To measure the mean value of the Southwick angle using two different methods, the manual (1) and digital (2) methods, and to establish a normality value.
Methods A primarily descriptive study with 100 children and adolescents. Individuals with orthopedic complaints regarding the hips and/or knees or gait alterations were excluded. For each patient, an X-ray was performed on the lateral incidence of Lowenstein, totaling 100 radiographs and 200 hips. The Southwick angle was measured in two different ways by the same researcher: the conventional method (1), tracing the lines with pencils and measuring the angle with the use of a goniometer and negatoscope, and through the GNU Image Manipulation Program (GIMP) image editor (open source), version 2.7.0 (2), in which the lines were plotted and the angles of both hips were gauged on each radiograph. Later, we sought to evaluate the correlation between the two methods and to verify the mean Southwick angle by categorically correlating it by gender, age group and body mass index (BMI) in asymptomatic children and adolescents. All radiographs were authorized by the children and adolescents' parents/legal guardians. The study was approved by the ethics committee of the institutions in which the research was conducted.
Results The mean of the Southwick angles obtained by the conventional method was of 8.7° (±2.0°), and, by the digital method, it was of 9.9° (±1.8°). The angle obtained by the two methods was statistically significant (p < 0.001). The majority of the studied population (95%) had a body mass index (BMI) > 18.5, and the mean of the angles was within the previously established value (∼ 10°).
Conclusion For the first time, using a substantial sample size, a normal value for the Southwick angle measured in asymptomatic individuals was demonstrated. In addition, the image editor proved to be a reliable method to measuring the Southwick angle.
* Work performed at Hospital da Restauração Governador Paulo Guerra, Recife, PE, Brazil.
- 1 Monin JO, Gouin F, Guillard S, Rogez JM. [Late results of the treatment of the slipped upper femoral epiphysis (26 cases with follow-up study over 10 years)]. Rev Chir Orthop Repar Appar Mot 1995; 81 (01) 35-43
- 2 Westhoff B, Schröder K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. Radiological outcome and gait function of SCFE patients after growth arrest. J Child Orthop 2013; 7 (06) 507-512
- 3 Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967; 49 (05) 807-835
- 4 Jingushi S, Suenaga E. Slipped capital femoral epiphysis: etiology and treatment. J Orthop Sci 2004; 9 (02) 214-219
- 5 Krauspe R, Weinstein S. Special symposium issue: slipped capital femoral epiphysis (SCFE). J Child Orthop 2017; 11 (02) 85-86
- 6 Tresoldi I, Modesti A, Dragoni M, Potenza V, Ippolito E. Histological, histochemical and ultrastructural study of slipped capital femoral epiphysis. J Child Orthop 2017; 11 (02) 87-92
- 7 Current concepts review. Slipped capital femoral epiphysis. J Bone Joint Surg Am 1990; 72 (04) 631-633
- 8 Örtegren J, Peterson P, Svensson J, Tiderius CJ. Persisting CAM deformity is associated with early cartilage degeneration after Slipped Capital Femoral Epiphysis: 11-year follow-up including dGEMRIC. Osteoarthritis Cartilage 2018; 26 (04) 557-563
- 9 Helgesson L, Johansson PK, Aurell Y, Tiderius CJ, Kärrholm J, Riad J. Early osteoarthritis after slipped capital femoral epiphysis. Acta Orthop 2018; 89 (02) 222-228
- 10 Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am 1993; 75 (08) 1141-1147
- 11 Griffith MJ. Slipping of the capital femoral epiphysis. Ann R Coll Surg Engl 1976; 58 (01) 34-42
- 12 Ward WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital femoral epiphysis. J Bone Joint Surg Am 1992; 74 (06) 799-809
- 13 Herngren B, Stenmarker M, Vavruch L, Hagglund G. Slipped capital femoral epiphysis: a population-based study. BMC Musculoskelet Disord 2017; 18 (01) 304
- 14 Perry DC, Metcalfe D, Costa ML, Van Staa T. A nationwide cohort study of slipped capital femoral epiphysis. Arch Dis Child 2017; 102 (12) 1132-1136
- 15 Aronson DD, Loder RT. Slipped capital femoral epiphysis in black children. J Pediatr Orthop 1992; 12 (01) 74-79
- 16 Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 1993; 75 (08) 1134-1140
- 17 Damaceno FL, Santili C, Longui CA. Normal reference values of Southwick's anteroposterior angle in prepubertal and pubertal normal adolescents. J Pediatr Orthop B 2007; 16 (06) 389-392
- 18 Steel HH. The metaphyseal blanch sign of slipped capital femoral epiphysis. J Bone Joint Surg Am 1986; 68 (06) 920-922
- 19 Millis MB. SCFE: clinical aspects, diagnosis, and classification. J Child Orthop 2017; 11 (02) 93-98
- 20 Santili C, de Assis MC, Kusabara FI, Romero IL, Sartini CM, Longui CA. Southwick's head-shaft angles: normal standards and abnormal values observed in obesity and in patients with epiphysiolysis. J Pediatr Orthop B 2004; l 13 (04) 244-247
- 21 Baecker V. Image J Macro Tool Sets for Biological Image Analysis. Disponível em: https://www.researchgate.net/profile/Volker_Baecker/publication/273769192_ImageJ_Macro_Tool_Sets_for_Biological_Image_Analysis/links/550c039c0cf2528164dae59a/ImageJ-Macro-Tool-Sets-for-Biological-Image-Analysis.pdf?origin=publication_detail
- 22 Subburaj K, Ravi B, Agarwal M. Computer-aided methods for assessing lower limb deformities in orthopaedic surgery planning. Comput Med Imaging Graph 2010; 34 (04) 277-288
- 23 Aversano MW, Moazzaz P, Scaduto AA, Otsuka NY. Association between body mass index-for-age and slipped capital femoral epiphysis: the long-term risk for subsequent slip in patients followed until physeal closure. J Child Orthop 2016; 10 (03) 209-213
- 24 Crawford AH. Slipped capital femoral epiphysis. J Bone Joint Surg Am 1988; 70 (09) 1422-1427
- 25 Santili C, Akkari M, Waisberg G, Braga SR, Kasahara A, Perez MC. Evolution of slipped capital femoral epiphysis after nonsurgical treatment. Rev Bras Ortop 2015; 45 (05) 397-402
- 26 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
- 27 Fujiki EM, Honda EK, Pradal A, Téo JB, Seixas LF, Porto LC. Epifisiólise femoral grau III: proposta de uma metodologia parao estudo radiográfico. Rev Bras Ortop Pediatr 2002; 3 (01) 28-33