Introduction Intraoperative monitoring of epiphyseal perfusion in slipped capital femoral epiphysis (SCFE) is a procedurally simple and readily accessible percutaneous technique to accurately guide decision-making and help to prevent osteonecrosis.
Indications & Contraindications
Step 1: Patient Preparation and Positioning Following anesthesia induction, position the patient and assess the physeal stability fluoroscopically to determine the need for a reduction.
Step 2: Guidewire Placement Place a 3.2-mm threaded guidewire from the anterolateral aspect of the femur to provide initial stability of the slipped epiphysis.
Step 3: Initial Screw Insertion Insert a cannulated 7.0-mm stainless steel screw over the guidewire to a point just past the physis.
Step 4: Preparation and Insertion of the ICP Probe Once the screw has been inserted to obtain provisional stability of the physis, remove the guidewire and insert a sterile ICP probe down the screw shaft to assess the epiphyseal perfusion.
Step 5: Hip Decompression If a perfusion pressure and waveform cannot be obtained, perform decompression of the hip capsule by either aspiration or capsulotomy.
Step 6: Epiphyseal Perfusion Reassessment Following the capsulotomy, reinsert the ICP probe and reassess the epiphyseal perfusion.
Step 7: Final Screw Advancement Once epiphyseal blood flow can be confirmed, reintroduce the guidewire to its previous depth and advance the screw to the final measured depth.
Results Utilizing this technique over a 5-year period, >35 patients were treated with the described technique, and 23 of them, including 29 hips, were included in our referenced prospective study3.
Pitfalls & Challenges
Intraoperative monitoring of epiphyseal perfusion in slipped capital femoral epiphysis (SCFE) is a procedurally simple and readily accessible percutaneous technique to accurately guide decision-making and help to prevent osteonecrosis. Osteonecrosis of the femoral head is one of the most dreaded complications of slipped capital femoral epiphysis. It is hypothesized that increased intracapsular …
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