Increased intracapsular pressures after unstable slipped capital femoral epiphysis.
BACKGROUND
Osteonecrosis of the femoral head is the most dreaded complication associated with an unstable slipped capital femoral epiphysis (SCFE). We hypothesize that the hip joint pressure will be increased in unstable slips, confirming that emergent treatment and decompression are warranted.


METHODS
Thirteen unstable SCFE hips were evaluated. Hip pressure monitoring was performed. Postcapsulotomy measurements were also performed in all of the patients. Five of these under gentle manipulation. Six patients underwent measurement of the hip pressure on the unaffected side.


RESULTS
The mean pressure on the affected hip was 48 mm Hg. The mean pressure on the unaffected side was 23 mm Hg. There was a significant increase in intraarticular hip pressure after attempted manipulation (mean, 75 mm Hg).


CONCLUSIONS
Hip pressures are increased in unstable SCFE to levels higher for those of a compartment syndrome probably causing a tamponade effect. There is a need to perform a capsulotomy if manipulation is performed.
Herrera-Soto
Jose A
JA
Orlando Regional Medical Center, Orlando, FL, USA. jose.herrera@orlandohealth.com
Duffy
Michael F
MF
Birnbaum
Mark A
MA
Vander Have
Kelly L
KL
D000293:Adolescent; D002648:Child; D019299:Decompression, Surgical / Q000379:methods; D004839:Epiphyses, Slipped / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005270:Femur Head / Q000473:pathology*; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D011312:Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index