My Technique for Stable SCFE Pinningmy technique for stable scfe pinning martin j. herman md...
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My Technique for Stable SCFE Pinning MARTIN J. HERMAN MD PROFESSOR OF ORTHOPEDIC SURGERY AND PEDIATRICS DREXEL UNIVERSITY COLLEGE OF MEDICINE ST. CHRISTOPHER’S HOSPITAL FOR CHILDREN PHILADELPHIA, PA
Transcript of My Technique for Stable SCFE Pinningmy technique for stable scfe pinning martin j. herman md...
My Technique for Stable SCFE Pinning
M A R T I N J . H E R M A N M D
P R O F E S S O R O F O R T H O P E D I C S U R G E R Y A N D P E D I A T R I C S
D R E X E L U N I V E R S I T Y C O L L E G E O F M E D I C I N E
S T . C H R I S T O P H E R ’ S H O S P I T A L F O R C H I L D R E NP H I L A D E L P H I A , P A
12 yo girl complaining of R knee painWalking with a limp x 6 weeks
Examination
R out-toed gait
R hip ROM Flexion 0-110°
Abduction 50°
IR 10°, ER 60°
Radiographs
Diagnosis: Stable Grade 1 SCFE
Type : Idiopathic Age 12
No risk factors
Thyroid disease
Renal disease
Loder Classification: Stable Walking
“Chronic SCFE”
Grade 1 <25% slip
Treatment : IN SITU SCREW FIXATION
Admit
Next-day surgery
Bedrest
Preop discussion:
Surgery to prevent progression/acute slip
Percutaneous technique
Complications Infection
Implant issues
Future surgery
Opposite hip
FAI
OR Set-Up
Radiolucent table Fracture table
C-arm from side opposite of the SCFE or 2 C-arms
Lovell and Winter’s 7th edition, Pediatric Orthopedics, 2014
Step 1Mark the Incision Site
A
B
C D
Anterior Hip Incision
Step 2Place the Guide Wire
6.5-7.3mm cannulated screw set
Limited passes
Stress riser
Avoid bending the wire
Can CROSS-CUT the wire
Guidewire Central in Epiphysis
Entry Point of the Screw
ANTERIOR neck
Grade 1 or more
Aim posteriorly
Pre- or minimal slips
Lateral metaphysis
Above lesser trochanter
RISK of fracture if too distal
Step 3Overdrill the Guidewire
Clean drill flutes at 4-6 cm
Drill up to the physis
CHECK that the wire does not advance
Step 4Place the Screw over the Guidewire
Measure length
Fully threaded (or long-threaded) Compression (lag effect) NOT necessary
IDEAL Placement• NOT in joint• Central in epiphysis• 4-5 threads across physis
Step 5Critically Assess Screw Placement
LIVE fluoroscopy NOT in the joint
NOT proximal to intertrochanteric line
Impingement
NOT too long
Loosening
Goodwin et al, JPO, 2006
BAD – IMPINGES IN FLEXION
GOOD
Post-Op Care
Crutches x 4 weeks
TTWB
Active ROM at home Follow-up
1 w for ROM/wound check
4 w for XR
Begin PT
Q4 months for exam and XR
Assess physeal closure
Check for contralateral SCFE (30%)
