Tim Schrader1, K Aaron Shaw2. 1. Children's Orthopaedics of Atlanta, Atlanta, Georgia. 2. Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.
Abstract
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. 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.
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. 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.
Authors: J Benjamin Jackson; Steven L Frick; Brian K Brighton; Scott R Broadwell; Eric A Wang; Virginia F Casey Journal: J Pediatr Orthop Date: 2018-02 Impact factor: 2.324
Authors: Eduardo N Novais; Ernest L Sink; Lauryn A Kestel; Patrick M Carry; João C M Abdo; Travis C Heare Journal: Clin Orthop Relat Res Date: 2016-04-18 Impact factor: 4.176