Salvage of failed in-situ pinning in severe unstable slipped capital femoral physis by surgical dislocation and capital realignment.

AIMS

We describe surgical dislocation with capital realignment as an option for management of failed in-situ pinning in children with severe unstable slipped capital femoral physis.

PATIENTS AND METHODS

A retrospective data collection from our hospital hip database retrieved 7 patients with severe unstable slipped capital femoral physis who had failed in-situ pinning with severe deformity and grossly restricted movements. The failure of pinning in-situ was due to slip progression with inadequate screw purchase in four patients, stress fracture of the femoral neck in one patient, and screw head impingement in two patients. All these patients under went open surgical dislocation, removal of the screws, followed by sub-capital realignment and fixation.

RESULTS

The average age at presentation was 11.9 years (10-14 years). The mean follow-up was 50.14 months (25-66 months). Four patients who had pre-existing avascular necrosis at presentation underwent second stage hinged distraction of the hip joint. Preoperatively, the mean Modified Harris Hip Score (MHHS) was 19.57 (0-56) and the mean Non-Arthritic Hip Score (NAHS) was 21.07 (5-51.5) respectively. The mean MHHS at the last follow-up visit was 88.97 (71-96) and NAHS was 84.28 (69.5-91) respectively.

CONCLUSION

Allowing the hip to heal in its anatomical position is the best possible correction we could give for any patient with severe slipped capital femoral epiphysis. We found that surgical dislocation for those with failed in-situ pining proved to be an effective bailout option for restoration of anatomy and function.