title: Slipped capital femoral epiphysis: relevant pathophysiological findings with open surgery.
abstract: BACKGROUND
  Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation.
  
  
  OBJECTIVE
  We (1) determined the influence of chronicity of prodromal symptoms and severity of SCFE deformity on severity of cartilage damage. (2) In surgically confirmed disconnected epiphyses, we determined the influence of injury and time to surgery on epiphyseal perfusion; and (3) the frequency of new bone at the posterior neck potentially reducing perfusion during epimetaphyseal reduction.
  
  
  METHODS
  We reviewed 116 patients with 119 SCFE and available records treated between 1996 and 2011. Acetabular cartilage damage was graded as +/++/+++ in 109 of the 119 hips. Epiphyseal perfusion was determined with laser-Doppler flowmetry at capsulotomy and after reduction. Information about bone at the posterior neck was retrieved from operative reports.
  
  
  RESULTS
  Ninety-seven of 109 hips (89%) had documented cartilage damage; severity was not associated with higher slip angle or chronicity; disconnected epiphyses had less damage. Temporary or definitive cessation of perfusion in disconnected epiphyses increased with time to surgery; posterior bone resection improved the perfusion. In one necrosis, the retinaculum was ruptured; two were in the group with the longest time interval. Posterior bone formation is frequent in disconnected epiphyses, even without prodromal periods.
  
  
  CONCLUSIONS
  Addressing the cause of cartilage damage (cam impingement) should become an integral part of SCFE surgery. Early surgery for disconnected epiphyses appears to reduce the risk of necrosis. Slip reduction without resection of posterior bone apposition may jeopardize epiphyseal perfusion.
  
  
  METHODS
  Level IV, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Inselspital, Berne, Switzerland.
authors: Kai
authors: K
authors: Ziebarth
authors: Michael
authors: M
authors: Leunig
authors: Theddy
authors: T
authors: Slongo
authors: Young-Jo
authors: YJ
authors: Kim
authors: Reinhold
authors: R
authors: Ganz
mesh_terms: D000077:Acetabulum / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D000293:Adolescent; D001900:Boston; D002648:Child; D002908:Chronic Disease; D005260:Female; D057925:Femoracetabular Impingement / Q000209:etiology / Q000473:pathology; D006132:Growth Plate / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D009336:Necrosis; D019637:Orthopedic Procedures; D011379:Prognosis; D011859:Radiography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012720:Severity of Illness Index; D060048:Slipped Capital Femoral Epiphyses / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D013557:Switzerland
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