Surgical treatment for severe slipping of the upper femoral epiphysis

Abstract

We have used a modified technique of cervical osteotomy to treat a consecutive series of 23 patients with chronic slip of the upper femoral epiphysis. It has been successful in correcting both moderate and severe deformities with a low incidence of avascular necrosis, comparable to that seen after subtrochanteric osteotomies. We describe the operative details and discuss the features which make cervical osteotomy technically superior to intertrochanteric and subtrochanteric procedures.

Capital Realignment for Moderate and Severe SCFE Using a Modified Dunn Procedure

“…To reduce the risk for osteonecrosis of the epiphysis during capital reorientation, tension of the posterosuperior retinaculum, containing the end branches of the medial femoral circumflex artery, is reportedly reduced by cuneiform wedge resection of varying size and location [12,14,16,19,45]. Removing the remainder of the growth plate provides an additional surgical step to accelerate consolidation and foster revascularization of the epiphysis [19].…”

“…Removing the remainder of the growth plate provides an additional surgical step to accelerate consolidation and foster revascularization of the epiphysis [19]. Despite such caution, osteonecrosis reportedly occurs with an incidence of 10% to 100% [3, 4, 9, 10, 12, 14, 18, 20-22, 36, 43, 47, 54, 58, 59], and the combination of osteonecrosis and chondrolysis [60] up to 42% [3,10,12,21,22,58].…”

Osteotomia triplanar no tratamento do escorregamento epifisário proximal do fêmur

“…Alguns autores descreveram bons resultados finais com a fixação in situ com parafuso canulado único, mesmo em escorregamentos graves, justificando que o potencial de remodelação óssea do fêmur proximal seria suficiente para restabelecer uma boa função à articulação do quadril (1)(2)18) , mas essa conduta não é respaldada em outros trabalhos (3,17) .…”

“…Autores têm demonstrado bons resultados, a longo prazo, inclusive em escorregamentos graves, demonstrando que a articulação do quadril tem grande potencial de remodelação (1)(2) . Outros, porém, defendem que, em casos de deslizamento superior a 30 o , submetidos à epifisiodese, a remodelação femoral não seria suficiente para restabelecer a biomecânica normal da articulação e, conseqüentemente, evitar o surgimento precoce da osteoartrose (3)(4) . Estes pacientes deveriam ser submetidos a osteotomias femorais corretivas.…”

Current concepts in the treatment of adolescent femoroacetabular impingement

“…basi-cervical and sub-capital), the greater the potential for correction of chronic slip deformity in SCFE [56]; however, there is an increased risk of osteonecrosis and chondrolysis [57]. For example, osteonecrosis has been reported to occur at a rate of 10-100 % [58][59][60].…”