Diagnosis and repositioning technique of slipped femoral epiphysis

  Slipped Capital Femoral Epiphysis (SCFE) in children and adolescents has an unclear etiology, but is not uncommon and is easily misdiagnosed and missed. It is most common in adolescent children aged 12-17 years, but can also be seen in young males with non-significant secondary sexual characteristics.  The symptoms of the disease include hip pain radiating to the knee, limb limp and internal and external rotation, limited abduction and flexion, and the main radiographic manifestations are downward and posterior displacement of the femoral head, widening, roughness and irregularity of the epiphysis, shortening and widening of the femoral neck, and flattening of its upper edge.  SCFE is generally classified into acute, subacute and chronic stages (Dunn, 1978), mild, moderate and severe according to the degree of slippage, and stable SCFE and unstable SCFE according to the degree of stability. For a long time, the treatment methods for SCFE are limited, mainly using in situ fixation, closed reduction and incisional reduction. In-situ fixation cannot restore the anatomical structure of the femoral head neck, and after treatment, the femoral head neck deformity remains to a greater or lesser extent, with limited hip flexion/internal rotation, early cartilage damage (nearly 90%) and hip osteoarthritis secondary to hip impingement; while the incidence of femoral head necrosis is very high (nearly 60%) after conventional incisional resurfacing.  Professor Ganz, with accurate blood supply to the femoral head and protection of blood flow to the femoral epiphysis, suggested that SCFE repositioning (2009) or subtrochanteric osteotomy (Dunn’s osteotomy) could be performed by hip surgical dislocation technique, which avoided the residual deformity of the hip joint, minimized the occurrence of femoral head necrosis, and could effectively prevent the occurrence of hip osteoarthritis.