Slipped upper femoral epiphysis : Percutaneous pinning with Synthes 73 mm cannulated screws
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Slipped capital femoral epiphysis (SCFE, SUFE) has an incidence of between 5-10 per 100,000 children per year, generally occurring during the adolescent growth spurt. The majority of slips are slowly progressive over weeks or months.
It is well accepted that the gold standard of treatment for mild and moderate (grade I/II) SCFE is percutaneous pin stabilisation. The same technique can also be used for grade III severe SCFE although long term results are less favourable.
For stable SCFE percutaneous pinning can be performed ‘freehand’ on a standard operating table as described here. The image intensifier remains static and the hip is flexed and externally rotated to achieve a lateral view.
Under X ray guidance a guide wire is passed across the central portion of the physis. A screw is then passed over the guide wire (6.0-8.0mm diameter) with the aim of engaging a minimum of 5 threads past the physis.
An associated techniques to deal with the later presenting slipped upper femoral epiphysis is dealt with on OrthOracle at https://www.orthoracle.com/library/dunns-osteotomy/
Author: Mr Christopher Edward Bache FRCS(Tr & Orth)
Institution: The Birmingham Childrens’ Hospital, Birmingham, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.