Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  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

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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 5:151–157

    Article  CAS  Google Scholar 

  6. Jones JR, Paterson DC, Hillier TM, Foster BK (1990) Remodelling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg (Br) 72:568–573

    CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dunn DM (1964) The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg (Br) 46:621–629

    CAS  Google Scholar 

  13. Fish JB (1984) Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 66:1153–1168

    CAS  PubMed  Google Scholar 

  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:947–954

  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. 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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  18. DeRosa GP, Mullins RC, Kling TF (1996) Cuneiform osteotomy of the femoral neck in severe slipped capital femoral epiphysis. Clin Orthop 322:48–60

  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 6:437–442

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  21. Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 49:807–835

    CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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) 84:556–560

    Article  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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 63:85–95

    CAS  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Orthopaedic Surgery, Rizzoli Sicilia Department, Rizzoli Orthopaedic Institute, Bagheria, PA, Italy

    Cesare Faldini, Marcello De Fine, Daniele Fabbri, Raffele Borghi, Camilla Pungetti & Francesco Traina

  2. UOC Orthopaedics and Trauma Surgery, University Campus Bio-Medico, Rome, Italy

    Alberto Di Martino

  3. Department of Orthopaedic Surgery, Istituti Ortopedici Rizzoli, Dipartimento Rizzoli-Sicilia, SS 113, km 246, Bagheria, PA, 90011, Italy

    Marcello De Fine

Authors
  1. Cesare Faldini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcello De Fine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Di Martino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniele Fabbri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raffele Borghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Camilla Pungetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Traina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello De Fine.

Ethics declarations

Conflict of interest

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

(WMV 72671 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faldini, C., De Fine, M., Di Martino, A. et al. Anterior minimally invasive subcapital osteotomy without hip dislocation for slipped capital femoral epiphysis. International Orthopaedics (SICOT) 40, 1615–1623 (2016). https://doi.org/10.1007/s00264-015-3015-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-3015-0

Keywords

Search

Navigation