Trapezoid osteotomy for slipped capital femoral epiphysis

Abstract

Twenty-three patients with chronic or acute to chronic slip of the capital femoral epiphysis were treated using a modified trapezoid osteotomy of the femoral neck. All slips were greater than 60°. After a follow-up period of 70 (54-93) months, the results were excellent or good in 18 hips, fair in 1, and poor in 4 hips. Avascular necrosis developed in 3 hips, and chondrolysis in 2.Résumé 23 patients avec épiphysiolyse fémorale supé-rieure de l'adolescent ont été traités utilisant une ostéoto-mie modifiée avec résection trapézo sous-capitale. Tous les déplacement ont été de plus de 60 degrees. La moyenne de la période d'étude a été de 70 mois (54-93 mois). On a retrouvé un resultat excellent ou bon en 18 hanches, passable en 1, et médiocre en 4 hanches. La nécrose céphalique s'est developpée en 3 hancles et la chondrolyse en 2.

What Is the Best Evidence for the Treatment of Slipped Capital Femoral Epiphysis?

“…Treatment options for a stable SCFE include: (1) in situ stabilization with a single screw 9,10,21-25 or multiple pins 1,21,26-28 ; (2) epiphysiodesis 28-33 ; (3) open reduction with corrective osteotomy through the physis and internal fixation 1,22,[33][34][35][36][37][38][39][40][41][42] ; (4) basilar neck osteotomy 43-45 ; (5) intertrochanteric osteotomy 27,[45][46][47][48][49] ; and (6) surgical dislocation of the hip with modified Dunn osteotomy, reduction, and fixation. 18,[50][51][52][53] A composite of the literature is shown in Tables 1 and 2.…”

Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis

“…Six studies (273 hips) reported on fixation in situ using multiple smooth pins [ 35 , 42 , 44 , 45 , 47 , 56 ] (Table 7 ). Seventeen studies (615 hips) reported on primary corrective subcapital femoral osteotomy [ 3 , 30 , 33 , 35 , 41 , 56 – 66 , 70 ] (Table 8 ). Seven studies (95 hips) reported on safe surgical dislocation using the Ganz technique [ 43 , 51 , 52 , 67 – 70 ] (Table 9 ).…”

“…Carlioz et al [ 30 ] used a scale omitting “excellent”. A few authors omitted “failure” in their scales [ 31 – 33 ]. We pooled data as reported in the included studies without assumption or improvisation.…”

Sugiokaʼs Modified Hungria-Kramer Intertrochanteric Osteotomy in the Treatment of Severe Slipped Capital Femoral Epiphysis

“…8,14,[37][38][39] Despite their greater potential for realignment due to the proximity to the site of deformity, most femoral neck osteotomies are associated with a high incidence of avascular necrosis of the proximal femoral epiphysis, which can be explained by the fact that the manipulation during the operation may be a risk factor for the integrity of retinacular vessels of the neck. 8,9,27,40 Extracapsular osteotomies are designed to spare the blood vessels responsible for the nutrition of the femoral head from being jeopardized and can be performed either at the intertrochanteric or subtrochanteric regions.…”