Percutaneous Screw Fixation of Slipped Capital Femoral Epiphysis (SCFE)

Michael B. Millis, MD

Patient Positioning

Supine on a radiolucent table (preferred) with affected leg prepped free
- Fracture table is an alternative but traction can be risky for the slipping physis
C-arm coming from the contralateral side of the radiolucent table
- Ability to obtain complete orthogonal fluoroscopic views of hip (AP and lateral)
- Receiver above patient. Beam directed toward ceiling. Proximity of receiver, greater distance of beam source from patient allows lower radiation dose to patient
Ipsilateral arm placed across the chest

Surgical Approaches

This is a percutaneous approach with the goal to place the guidewire perpendicular to physis in the middle of femoral head, with the screw tip approaching subchondral bone
Before incision: baseline C-arm imaging to ensure adequate visualization
- Beam directed perpendicular AP and lateral fluoroscopic views of the hip are obtained
- Prep and draping
  - NB: stability of physis is always uncertain, so be careful in moving the affected leg
- Preferred draping: whole leg free up to iliac crest
- Incision localization: place a free guidewire over the anterior surface of the proximal thigh to localize the femoral neck. Check with the C-arm
- Skin marker is placed over the skin to outline tentative anterolateral entry point and tentative trajectory directed proximally and medially and traced back with a marking pen
  
  Figure 18-1 ▪ Fluoroscopy image obtained with the guidewire over thigh showing correct trajectory.
- AP C-arm view with guidewire used over skin to mark correct trajectory(Figure 18-1)
- Lateral view with guidewire aiding to mark the lateral femur
  - Safest to rotate the C-arm rather than the leg, to minimize risk of causing further slip
The tentative entry site of the guidewire is where these two lines meet on the anterolateral surface of the proximal thigh

Reduction technique

All acute reduction maneuvers involve some vascular risk to the femoral head and are beyond the scope of this chapter.

Fixation Technique

Feb 5, 2020 | Posted by drzezo in ORTHOPEDIC | Comments Off

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