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  • Title: Windshield-wiper loosening: a complication of in situ screw fixation of slipped capital femoral epiphysis.
    Author: Maletis GB, Bassett GS.
    Journal: J Pediatr Orthop; 1993; 13(5):607-9. PubMed ID: 8376561.
    Abstract:
    A retrospective review of patients treated for slipped capital femoral epiphysis (SCFE) by in situ screw fixation with a cannulated titanium screw was performed. Of the 18 hips with at least 1-year follow-up, windshield-wiper loosening of the cannulated screw in the femoral head had occurred in three. In all three cases, the screw had been left protruding > 1.5 cm from the anterolateral cortex of the femur. We postulate that with hip motion the protruding screw is toggled by the anterolateral soft tissues, causing a windshield-wiper effect in the femoral head, leading to eventual screw loosening. We believe that leaving the screw protruding from the fascia lata is a potential source of screw loosening by the windshield-wiper mechanism and now routinely place the screw head within 1.5 cm of the anterolateral cortex of the femur.
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