Percutaneous Fixation of Slipped Capital Femoral Epiphysis

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Stable or unstable slipped capital femoral epiphysis (SCFE)
  • Prophylactic treatment of the contralateral hip in patient with SCFE
CONTRAINDICATIONS

There are no specific contraindications for percutaneous pinning of SCFE.

EQUIPMENT
  • Fluoroscope
  • Fracture table
  • Kirschner wires
  • Drill
  • Cannulated pediatric hip screw set
ANATOMY
  • The terminal branch of the medial femoral circumflex artery is the primary blood supply of the femoral head and injury to this can lead to the development of osteonecrosis.
  • Pin placement should avoid the posterosuperior quadrant of the epiphysis to avoid the important arteries of the femoral head and neck.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Technique Described by Canale et al
  • Post-Procedure: Technique Described by Morrissy

Post-Procedure: Technique Described by Canale et al

POST-PROCEDURE CARE
  • Begin range of motion exercises on postoperative day 1.
  • Partial weight-bearing with crutches
    • 2-3 weeks for stable fractures
    • 6-8 weeks for unstable fractures
  • Restrict athletic activity until physis closes.
  • Screw removal is optional after the physis is closed.
COMPLICATIONS
  • Osteonecrosis (ON): risk 0% to 5%
  • Chondrolysis (cartilage necrosis)
  • Femoral neck or subtrochanteric fracture
ANALYSIS OF RESULTS
  • Good results in 95% of hips treated with single-screw fixation and low complication rate
OUTCOMES AND EVIDENCE
  • Aronson and Carlson (1992): excellent or good results in 36 of 38 hips with mild SCFE, 10 of 11 hips with moderate SCFE, and 8 of 9 hips with severe SCFE
  • Carney, Weinstein, and Noble (1991): in situ pinning showed best long-term function, low complication rate, and delay of arthritis regardless of severity of the slip.
  • Goodman, Johnson, and Robertson (1996): excellent (17) or good (3) results in 20 of 21 hips with acute or acute-on-chronic slips treated with single-screw fixation.
  • Herman et al (1996): 100% effective stabilization in grade III slips treated with screw fixation
  • Kenney et al (2003): excellent or good results in 94% of hips and 5% complication rate
Procedure: Technique Described by Canale et al

Post-Procedure: Technique Described by Morrissy

POST-PROCEDURE CARE
  • Begin range of motion exercises on postoperative day 1.
  • Partial weight-bearing with crutches
    • 2-3 weeks for stable fractures
    • 6-8 weeks for unstable fractures
  • Restrict athletic activity until physis closes.
  • Screw removal is optional after the physis is closed.
COMPLICATIONS
  • Osteonecrosis (ON): risk 0% to 5%
  • Chondrolysis (cartilage necrosis)
  • Femoral neck or subtrochanteric fracture
ANALYSIS OF RESULTS
  • Good results in 95% of hips treated with single-screw fixation and low complication rate
OUTCOMES AND EVIDENCE
  • Aronson and Carlson (1992): excellent or good results in 36 of 38 hips with mild SCFE, 10 of 11 hips with moderate SCFE, and 8 of 9 hips with severe SCFE
  • Carney, Weinstein, and Noble (1991): in situ pinning showed best long-term function, low complication rate, and delay of arthritis regardless of severity of the slip.
  • Goodman, Johnson, and Robertson (1996): excellent (17) or good (3) results in 20 of 21 hips with acute or acute-on-chronic slips treated with single-screw fixation.
  • Herman et al (1996): 100% effective stabilization in grade III slips treated with screw fixation
  • Kenney et al (2003): excellent or good results in 94% of hips and 5% complication rate
Procedure: Technique Described by Morrissy
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