Surgical management of unstable large displacement upper femoral epiphysiolysis

Abstract

Introduction: Superior femoral epiphysiolysis (SFE) is a slippage of the femoral head relative to the cervical growth plate. Unstable forms with large displacement have a high risk of femoral head necrosis and chondrolysis. Rapid reduction of epiphyseal displacement has been blamed for epiphyseal ischemia. Objective: We present here the anatomical results of a technique of progressive reduction of epiphyseal displacement by transtibial traction followed by percutaneous fixation of the femoral head with screws and/or pins. Patients and Methods: This was a retrospective descriptive study over a 10-year period from January 01, 2013 to December 31, 2022. It focused on the surgical treatment of unstable upper femoral epiphysiolysis with large displacement at the orthopedic trauma department of the Kati University Hospital. Continuous progressive traction on the Boppe splint through a pin under the anterior tibial tuberosity was performed for 15 days in all patients. The hip and knee were flexed to 90°. Fixation was performed with either one screw, two screws, or one screw and a pin. No contralateral preventive fixation was performed. Results: At final follow-up, all nine patients were asymptomatic. Radiologically, all nine patients had a femoral head free of epiphyseal necrosis. In eight patients, the posterior tilt was absent, identical to that obtained after the traction period (Figure 3). Only one patient had a moderate posterior tilt with a neck overhang of less than 25%. Functionally, the PMA score was very good in 8 cases and good in one case. Conclusion: This study shows that the treatment of acute and unstable forms of upper femoral epiphysiolysis by progressive reduction with transtibial traction is an effective technique. It allows a satisfactory reduction of the displacement, an easy fixation of the slip with a lower risk of necrosis of the femoral head and of chondrolysis.