The management of unstable slipped capital femoral epiphysis is controversial with variable rates of avascular necrosis (AVN). Treatment options include in-situ stabilization, gentle/positional reduction and screw fixation and modified Dunn’s procedure (MDP). We present a technique of controlled repositioning (CRP) of the epiphysis to pre-acute slip stage, screw fixation and primary osteoplasty. Between 2015 and 2020, 38 unstable slips were treated in our institution. Of these, 14 underwent successful CRP and the rest were treated with MDP. All the 14 patients who had CRP and completed 1-year follow-up were included for this study. The head–neck angle (HNA) was measured at presentation and alpha angle, head–neck offset and AVN were assessed during follow-up. The average age was 14 years (9–18) and mean follow-up was 17.7 months (12–43). The average intraoperative flexion internal rotation before osteoplasty was −18.5° (−40° to −5°) which improved to +22.1° (+15° to +30°). The average preoperative HNA was 48.7° (34.1° to 70.7°) which improved to 18.4° (1.8° to 35.7°) post-operatively. At final follow-up, the average alpha angle and head–neck offset were 46.4° (30.9° to 64.6°) and 0.22 (0.09 to 0.96), respectively. The AVN rate in the CRP group was 7.1% compared with 20.8% in the MDP group, which was not significant (P = 0.383). Two patients had screw breakage. CRP, screw fixation and mini-open primary osteoplasty is a feasible treatment option in a subgroup of patients with unstable SCFEs. The limitation with this technique is that the final decision is made intraoperatively, and hence the patient and parents need to be counselled and consented appropriately. Level of evidence: Level IV—Case series.
Background: Gastroschisis is a common neonatal malformation, with an incidence of 0.4-3 per 10,000 live births worldwide. Objective: This study was planned to assess the feasibility of bedside reduction of gastroschisis (BRG) in the neonatal intensive care unit (NICU) at our institution. Materials and Methods: Retrospective analysis of newborns with gastroschisis managed at our institution between September 2008 and May 2013. Initial bedside reduction in NICU was attempted in all the neonates procedure was done underlocal anesthesia. Incision was extended transversely on the lateral aspect when required. Gradual reduction of bowel loops done with monitoring of parameters. Complete abdominal wall closure in multiple layers/skin closure only was done based on intra-abdominal tension. The final outcome was recorded. Results: During the study period of 60-month, 10 children were treated for gastroschisis at our institution. The sex ratio among them was 8:2 in favor of males. The average age was 23 h (range: 4-72 h). The average birth weight of the babies was 2290 g (range: 1700-2600 g). Six patients were in the high-risk group and 4 in the low-risk group. The BRG was successful in 7 patients and a silo was placed in 3 patients who did not tolerate BRG. General anesthesia was required in 3 patients only for subsequent repair. The overall survival was 70%. Conclusion: BRG is a feasible and safe option. Selective use of silo, gradual staged bowel reduction, and delayed primary closure of the defect can be done on the bedside when attempted BRG is unsuccessful.
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