Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Schrader, Tim; Jones, Christopher Robert; Kaufman, Adam M.; Herzog, Mackenzie M.

doi:10.2106/jbjs.15.01002

Cited by 29 publications

(22 citation statements)

References 22 publications

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“…In all hips, we have been able to establish an epiphyseal waveform indicating perfusion. To date, none of our patients, including some with 5 years of follow-up and those in our study 3 with a minimum follow-up of 2 years, have developed osteonecrosis. Recent studies have validated the use of the ICP probe in monitoring for epiphyseal perfusion in patients undergoing a modified Dunn procedure for unstable SCFE, finding it an effective technique for identifying patients who may go on to develop osteonecrosis 4,5 .…”

Section: Resultsmentioning

confidence: 74%

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Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Schrader

Shaw

2017

JBJS Essential Surgical Techniques

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Section: Resultsmentioning

confidence: 74%

“…Utilizing this technique over a 5-year period, .35 patients were treated with the described technique, and 23 of them, including 29 hips, were included in our referenced prospective study 3 . In our patient cohort with SCFE, approximately 44% of the patients demonstrated an unstable SCFE.…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Schrader

Shaw

2017

JBJS Essential Surgical Techniques

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“…In an attempt to further reduce rates of osteonecrosis associated with unstable SCFE, Schrader et al 57 described a technique for intraoperative monitoring of epiphyseal perfusion. An intracranial pressure (ICP) probe was inserted percutaneously through a cannulated screw into the epiphysis.…”

Section: Capsulotomymentioning

confidence: 99%

The Etiology and Management of Slipped Capital Femoral Epiphysis

Haider¹,

Podeszwa²,

Morris³

2022

Journal of the Pediatric Orthopaedic Society of North America

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We review insights into slipped capital femoral epiphysis (SCFE) gained during the last decade and updates to current management practices. Anatomic and clinical studies recently demonstrate that the epiphysis rotates around an epiphyseal tubercle during displacement. Clinical endocrinopathies contribute to the pathogenesis of SCFE, and recently the effects of subclinical endocrine derangements have been demonstrated to play a role in SCFE. Patients with positive age-weight or age-height testing are recommended to undergo further endocrine workup due to the high likelihood of atypical SCFE in these patients. In situ pinning with two screws is mainly reserved for unstable or severe slips, while one-screw fixation remains the standard for mild-moderate slips. Contralateral prophylactic pinning is typically considered in those patients with an atypical slip, relative skeletal immaturity, or aberrant radiographic parameters such as posterior epiphyseal tilt or sloping angle. Novel intraoperative epiphyseal perfusion monitoring has provided insight into reducing complications such as avascular necrosis and has shown the benefit of intracapsular hematoma decompression for unstable SCFE. Open surgical management via the modified Dunn procedure should be cautiously considered, as high rates of osteonecrosis have been reported due to the vulnerable blood supply of the proximal femoral head. Key Concepts• The epiphyseal tubercle acts as a prominent stabilizer of the proximal femoral epiphysis and pivot point for a posterior rotation and displacement of the epiphysis during SCFE.• Hyperinsulinism and increased leptin concentrations lead to biochemical alterations of the proximal femoral physis that contribute to physeal failure.• Further endocrine and metabolic workup is needed for patients with a positive age-weight or age-height test due to the high likelihood of atypical SCFE.

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“…Additionally, certain approaches such as the modified Dunn osteotomy and open reduction may offer additional advantages of decreasing the long-term risks of FAI 93 . In cases of closed reduction and fixation, the ICP perfusion assessment may be helpful in determining the need for capsulotomy 82 . In our practice, we commonly perform a closed reduction followed by in situ fixation and capsulotomy within 24 hours of presentation.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and Management of Unstable Slipped Capital Femoral Epiphysis

Cazzulino

Allahabadi

et al. 2021

JBJS Reviews

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An unstable slipped capital femoral epiphysis (SCFE) is characterized by the inability to walk and is associated with a high risk of osteonecrosis.» An unstable SCFE is less common than a stable SCFE; however, the demographics are similar in both groups of patients with SCFE.» The diagnosis of an unstable SCFE is characterized by a history of antecedent pain and the inability to walk on examination, and it is confirmed by radiographic assessment.

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Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 29 publications

References 22 publications

Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

The Etiology and Management of Slipped Capital Femoral Epiphysis

Diagnosis and Management of Unstable Slipped Capital Femoral Epiphysis

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