Page 31 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Intertrochanteric osteotomies.
The intertrochantic osteotomies do not correct the deformity completely, but can
safely realign and downgrade the severity of the slip, especially if this procedure is
carried out at an early stage [28, 32, 115, 152]. This so called Southwick or Imhauser
osteotomy can be combined with an additional open femoral osteoplasty of the 2 cam lesion with a dental burr decreasing of femoral acetabular impingement in
time [12].
Lino et al. [66] describes a downgrading of the slip after the Southwick osteotomy from 56.9 degrees to a 19.1 degrees Southwick angle on the lateral radiograph. After an intertrochanteric flexion rotation osteotomy the clinical examination values and gait kinematics improved significantly. The short-term impact on the quality of life was shown in the improvements of the patient related outcome measurement (PROM) for children: the pediatric outcomes data collection instrument (PODCI) scores on basic mobility, sports function and global function [20]. The fixation of a Southwick osteotomy can be performed either by angle blade plate fixation or by an external fixation [54].
It is important to know that on evaluating a standard AP and frog lateral radiograph, the headshaft angles might be over- and/or underestimated. The preoperative planning of an osteotomy might be safer in future with a 3-dimensional CT [85, 114].
Arthroscopy in SCFE
A fairly new technique is the arthroscopic management of the femoroacetabular impingement by femoral neck osteochondroplasty. It maybe questioned if chondrolabral pathology is prevented by the femoral neck osteochondroplasty. Wylie et al. [158] found in all 9 arthroscopically treated patients, after an in situ screw fixation, some degree of labral and acetabular cartilage injury. After the osteochondroplasty, the alpha angle, and the functional outcomes are improved significantly. So far this treatment modality is forthcoming and it is yet unknown if it will prevent arthrosis at the hip joint [136, 160].
Complications associated with SCFE.
Avascular Necrosis.
A meta-analysis estimated that between 1993 and 2009 AVN occurred in 5.3 % of cases after surgical procedure in SCFE, but chondrolysis was rare with an estimated risk of 0.8 %. The risk of AVN in unstable SCFE was 9.4-fold greater [141].
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