[Slipped capital femoral epiphysis].
Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescence and should be diagnosed and treated surgically as soon as possible. The etiology, biomechanical, biochemical and hereditary factors are still under investigation. The classification of SCFE is based on the acuteness, clinical and radiomorphological findings. Avascular necrosis of the epiphysis (AVN) and chondrolysis occur more often in operated than in non-operated patients. Medium and long-term sequelae of SCFE are loss of function and degenerative joint disease due to femoroacetabular impingement (FAI) or consequences from complications such as AVN and chondrolysis. For mild slips the long-term prognosis is better than for moderate or severe slips. Higher grade unstable SCFE may benefit from reduction while in chronic slips corrective osteotomy may be indicated. Traditional osteotomy procedures, such as Imhäuser or Southwick intertrochanteric osteotomy are safe procedures but correct the deformity distant from the site of the deformity. The surgical dislocation with modified Dunn osteotomy according to Ganz allows the preparation of an extended retinacular soft tissue flap and offers an extensive subperiosteal exposure of the circumference of the femoral neck before reducing the slipped epiphysis anatomically. In cases of FAI due to mild deformities restoration of the head-neck offset via hip arthroscopy or surgical dislocation should be considered before higher grade cartilage damage occurs.
Zilkens
C
C
Orthopädische Klinik und Poliklinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland.
Jäger
M
M
Bittersohl
B
B
Kim
Y-J
YJ
Millis
M B
MB
Krauspe
R
R
D004839:Epiphyses, Slipped / Q000175:diagnosis / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D013524:Surgical Flaps