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International Orthopaedics

, Volume 40, Issue 8, pp 1615–1623 | Cite as

Anterior minimally invasive subcapital osteotomy without hip dislocation for slipped capital femoral epiphysis

  • Cesare Faldini
  • Marcello De FineEmail author
  • Alberto Di Martino
  • Daniele Fabbri
  • Raffele Borghi
  • Camilla Pungetti
  • Francesco Traina
Original Paper

Abstract

Purpose

A minimally invasive anterior approach appears to be an attractive alternative to achieve capital realignment without violating femoral head vascular supply and avoiding hip dislocation in slipped capital femoral epiphysis. The aim of this study was to detail the technical steps of subcapital realignment through a minimally invasive anterior approach and to report the preliminary results of this procedure in a prospective cohort of patients with stable slips.

Methods

Nine patients underwent subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation for moderate or severe stable slips between April 2012 and April 2013. Prophylactic stabilization of the contralateral hip was performed in all cases. A minimum 18 months follow-up was available. Clinical course was assessed using the Harris hip score and the hip range of motion. The degree of slippage as proposed by Southwick, the lateral α angle and the epiphyseal-metaphyseal distance allowed radiographic assessment.

Results

No patients were lost during follow-up, which was on average 28 months. No intraoperative complications occurred; one postoperative transient apraxia of the femoral cutaneous nerve, which completely recovered in six months, was recorded. Southwick angle, lateral α angle and epiphyseal-metaphyseal distance all improved substantially postoperatively. No cases of avascular necrosis were detected.

Conclusion

Subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation can be an easier alternative to restore proximal femoral anatomy in moderate to severe stable slips. Prospective case control studies are required to confirm these preliminary results.

Keywords

Slipped capital femoral epiphysis Osteotomy Outcomes Avascular necrosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest; no outside funding has been received for this study.

Supplementary material

ESM 1

(WMV 72671 kb)

References

  1. 1.
    Huber H, Dora C, Ramseier LE et al (2011) Adolescent slipped capital femoral epiphysis treated by a modified Dunn osteotomy with surgical hip dislocation. J Bone Joint Surg (Br) 93:833–838. doi: 10.1302/0301-620X.93B6.25849 CrossRefGoogle Scholar
  2. 2.
    Slongo T, Kakaty D, Krause F, Ziebarth K (2010) Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am 92:2898–2908. doi: 10.2106/JBJS.I.01385 CrossRefPubMedGoogle Scholar
  3. 3.
    Souder CD, Bomar JD, Wenger DR (2014) The role of capital realignment versus in situ stabilization for the treatment of slipped capital femoral epiphysis. J Pediatr Orthop 34:791–798. doi: 10.1097/BPO.0000000000000193 CrossRefPubMedGoogle Scholar
  4. 4.
    Lehmann TG, Engesæter IØ, Laborie LB et al (2011) In situ fixation of slipped capital femoral epiphysis with Steinmann pins. Acta Orthop 82:333–338. doi: 10.3109/17453674.2011.579520 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bellemans J, Fabry G, Molenaers G et al (1996) Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop Part B 5:151–157CrossRefGoogle Scholar
  6. 6.
    Jones JR, Paterson DC, Hillier TM, Foster BK (1990) Remodelling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg (Br) 72:568–573Google Scholar
  7. 7.
    Loder RT, Dietz FR (2012) What is the best evidence for the treatment of slipped capital femoral epiphysis? J Pediatr Orthop 32(Suppl 2):S158–165. doi: 10.1097/BPO.0b013e318259f2d1 CrossRefPubMedGoogle Scholar
  8. 8.
    Fraitzl CR, Käfer W, Nelitz M, Reichel H (2007) Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg (Br) 89:1592–1596. doi: 10.1302/0301-620X.89B12.19637 CrossRefGoogle Scholar
  9. 9.
    Leunig M, Casillas MM, Hamlet M et al (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71:370–375. doi: 10.1080/000164700317393367 CrossRefPubMedGoogle Scholar
  10. 10.
    Traina F, De Fine M, Abati CN et al (2012) Outcomes of total hip replacement in patients with slipped capital femoral epiphysis. Arch Orthop Trauma Surg 132:1133–1139. doi: 10.1007/s00402-012-1538-z CrossRefPubMedGoogle Scholar
  11. 11.
    Akiyama M, Nakashima Y, Kitano T et al (2013) Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. Int Orthop 37:2331–2336. doi: 10.1007/s00264-013-2047-6 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Dunn DM (1964) The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg (Br) 46:621–629Google Scholar
  13. 13.
    Fish JB (1984) Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 66:1153–1168PubMedGoogle Scholar
  14. 14.
    Pearl AJ, Woodward B, Kelly RP (1961) Cuneiform osteotomy in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 43-A:947–954Google Scholar
  15. 15.
    Novais EN, Hill MK, Carry PM et al (2014) Modified Dunn procedure is superior to in situ pinning for short-term clinical and radiographic improvement in severe stable SCFE. Clin Orthop Relat Res 473(6):2108–2117. doi: 10.1007/s11999-014-4100-1
  16. 16.
    Upasani VV, Matheney TH, Spencer SA et al (2014) Complications after modified Dunn osteotomy for the treatment of adolescent slipped capital femoral epiphysis. J Pediatr Orthop 34:661–667. doi: 10.1097/BPO.0000000000000161 CrossRefPubMedGoogle Scholar
  17. 17.
    Ziebarth K, Zilkens C, Spencer S et al (2009) Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop 467:704–716. doi: 10.1007/s11999-008-0687-4 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    DeRosa GP, Mullins RC, Kling TF (1996) Cuneiform osteotomy of the femoral neck in severe slipped capital femoral epiphysis. Clin Orthop 322:48–60Google Scholar
  19. 19.
    Swiontkowski MF, Thorpe M, Seiler JG, Hansen ST (1992) Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures. J Orthop Trauma 6:437–442CrossRefPubMedGoogle Scholar
  20. 20.
    Guo JJ, Tang N, Yang HL et al (2010) Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop 34:319–322. doi: 10.1007/s00264-009-0849-3 CrossRefPubMedGoogle Scholar
  21. 21.
    Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 49:807–835PubMedGoogle Scholar
  22. 22.
    Kohno Y, Nakashima Y, Kitano T et al (2014) Subclinical bilateral involvement of the hip in patients with slipped capital femoral epiphysis: a multicentre study. Int Orthop 38:477–482. doi: 10.1007/s00264-013-2131-y CrossRefPubMedGoogle Scholar
  23. 23.
    Nötzli HP, Wyss TF, Stoecklin CH et al (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg (Br) 84:556–560CrossRefGoogle Scholar
  24. 24.
    Leunig M, Horowitz K, Manner H, Ganz R (2010) In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop 468:3160–3167. doi: 10.1007/s11999-010-1408-3 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Boyer DW, Mickelson MR, Ponseti IV (1981) Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am 63:85–95PubMedGoogle Scholar
  26. 26.
    Kandzierski G, Matuszewski L, Wójcik A (2012) Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis. Int Orthop 36:2513–2520. doi: 10.1007/s00264-012-1699-y CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Biring GS, Hashemi-Nejad A, Catterall A (2006) Outcomes of subcapital cuneiform osteotomy for the treatment of severe slipped capital femoral epiphysis after skeletal maturity. J Bone Joint Surg (Br) 88:1379–1384. doi: 10.1302/0301-620X.88B10.17719 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2015

Authors and Affiliations

  • Cesare Faldini
    • 1
  • Marcello De Fine
    • 1
    • 3
    Email author
  • Alberto Di Martino
    • 2
  • Daniele Fabbri
    • 1
  • Raffele Borghi
    • 1
  • Camilla Pungetti
    • 1
  • Francesco Traina
    • 1
  1. 1.General Orthopaedic Surgery, Rizzoli Sicilia DepartmentRizzoli Orthopaedic InstituteBagheriaItaly
  2. 2.UOC Orthopaedics and Trauma SurgeryUniversity Campus Bio-MedicoRomeItaly
  3. 3.Department of Orthopaedic SurgeryIstituti Ortopedici Rizzoli, Dipartimento Rizzoli-SiciliaBagheriaItaly

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