Trapezoidal bony correction of the femoral neck in the treatment of severe acute-on-chronic slipped capital femoral epiphysis.
OBJECTIVE
To present the first technical description of a modified surgical technique for trapezoidal bony correction of the femoral neck in the treatment of slipped capital femoral epiphysis (SCFE), performed entirely by arthroscopy.


METHODS
From December 2005 to January 2008, 5 patients with severe SCFE underwent trapezoidal femoral neck bone correction through arthroscopy. Their mean age at the time of surgery was 13.2 years. The time for postoperative follow-up ranged from a minimum of 12 months to a maximum of 39 months (mean, 26 months). The study analyzed data regarding the type of slip, degree of correction obtained, clinical and functional outcomes, and complications.


RESULTS
Analysis with the modified Harris Hip Score criteria showed a mean of 17.2 points preoperatively and 86.6 points at the last assessment. The mean epiphyseal deviation ranged from 82° at the initial presentation to 14° postoperatively. There were no intraoperative complications, and there was 1 case of avascular necrosis.


CONCLUSIONS
Arthroscopic treatment of SCFE resulted in correction of the angles of epiphyseal slip (from a mean epiphyseal-diaphyseal angle of 82° before surgery to 14° after surgery), with no immediate complications and 1 case of a late complication (avascular necrosis) in this 5-patient series. Clinical improvement was shown by a mean 69.4-point increase in the modified Harris Hip Score.


METHODS
Level IV, therapeutic case series.
Akkari
Miguel
M
Pediatrics Division, Department of Orthopaedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil. miguel.akkari@gmail.com
Santili
Claudio
C
Braga
Susana Reis
SR
Polesello
Giancarlo Cavalli
GC
D000208:Acute Disease; D000293:Adolescent; D001182:Arthroscopy / Q000379:methods*; D001858:Bone Nails; D002648:Child; D018450:Disease Progression; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000628:therapy; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D051223:Trapezoid Bone / Q000601:surgery; D016896:Treatment Outcome