BERLIN — In situ pinning should be reassessed as a treatment method for mild slips of 30° or less in hips with slipped capital femoral epiphysis, according to a honorary lecturer at the 13th EFORT Congress 2012, here.
“There is increasing evidence that pinning in situ should be reassessed as a standard concept for treatment of [slipped capital femoral epiphysis]. Today, approaches are available to recreate normal hip anatomy with a safety buffer regarding avascular necrosis clearly higher than 50 years ago, when the late Erwin Morscher formulated a similar goal,” Reinhold Ganz, MD, said. “The surgical technique is demanding, but learnable.”
However, Ganz stressed that in situ pinning is only a temporary fix, as the literature shows that mild slips eventually lead to early osteoarthritis. The course of treatment should be determined by the degree of slip, he noted.
“Stop of further slipping is not the only goal of the treatment,” he said. “Impingement should be treated as well, even in minor slippage.”
Using results from the literature, Ganz also recommended – and cautioned against– using treatments for specific indications of slipped capital femoral epiphysis. Closed reduction should be avoided entirely, while open alignment with resection of the posterior callus through surgical dislocation and extended retinacular flap is advocated and use of K-wires is useful for stability, he said.
- Ganz R. Anatomic reconstruction of the hip with SCFE justified by pathophysiological findings. Erwin Morscher Honorary Lecture presented at the 13th EFORT Congress 2012. May 23-25. Berlin.