Subcapital femoral neck osteotomy without surgical hip dislocation in epiphyseolysis capitis femoris lenta with severe displacement

Abstract

The problem: Severe displacement in the lenta form of slipped capital femoral epiphysis leads to distinct joint incongruence with subsequent severe deformity, limitations of function and walking ability as well as early joint degeneration.

The solution: Subcapital femoral neck osteotomy restores the congruence of the hip joint as far as possible. This procedure is a so-called secondary prophylactic intervention.

Surgical technique: Disimpaction of the slipped epiphysis in several planes by wedge-shaped osteotomy in the subcapital region of the femoral neck (slippage is in a posterior and caudal direction). Careful preservation of the nutrient vessels to the femoral head within the posterior capsule. Stabilization of the osteotomy with cannulated screws with a short thread.

Results: The data reported in the literature vary greatly with regard to frequency and extent of femoral head necrosis. The present author holds the opinion that this risk is minimal, if the surgeon proceeds with care. Nevertheless, the indications for this procedure should be chosen with great reservation.