Staged Management of Osteonecrosis with Open Reduction and Hinged Distraction After a Slipped Capital Femoral Epiphysis: A Case Report.

Abstract

A slipped capital femoral epiphysis (SCFE) is most often seen in adolescents and can occur bilaterally in up to 25% of patients. It is the most common cause of hip pain in adolescence and is caused by weakness of the perichondrial ring and slippage of the proximal femoral epiphysis through the hypertrophic zone of the growth plate1. SCFE has an incidence of approximately two to three per 100,000 people2. Complications include osteonecrosis, chondrolysis, degenerative joint disease, chronic pain, gait abnormalities, and deformity3. We report a case of delayed presentation of SCFE following trauma, complicated by osteonecrosis. We managed this case with open reduction through the Ganz approach4 and internal fixation, followed by delayed hinged distraction with external fixation, achieving an excellent result. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. A ten-year-old girl with a body-mass index of 21 twisted her right leg while playing rugby at school. She was able to bear weight immediately but had a limp. A few days later, the right leg gave way and she was unable to bear weight. She presented to the emergency room and was subsequently referred to the Trauma and Orthopaedics Department. Radiographs revealed a severe SCFE (Fig. 1). She underwent an in situ single screw fixation of the right SCFE within twenty-four hours of presentation (at approximately one week after the injury) (Fig. 2). Fig. 1 Initial radiograph on admission showing a severe right SCFE. Fig. 2 Fig. 2 Intraoperative image intensifier film of the in situ screw fixation. On postoperative radiographs, rather than being central, the position of the screw was mostly posterior. Computed tomography (CT) demonstrated that the screw, which was in the posterior half of the femoral head, had not …