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Cuneiform Osteotomy Through Anterior Approach Without Hip Dislocation in Slipped Capital Femoral Epiphysis

February 01, 2014

Contributors: Francesco Traina, MD, PhD; Marcello De Fine, MD; Mateo Nanni, MD; Fabrizio Perna; Camilla Pungetti, MD; Antonio Mazzotti, MD; Carlotta Calamelli, MD; Sandro Giannini, MD; Cesare Faldini, MD; Cesare Faldini, MD

Slipped capital femoral epiphysis (SCFE) is a disorder of the adolescent hip affecting the physeal plate and causing slippage of the femoral epiphysis in a downward and backward direction in respect to the metaphysis. SCFE can be classified as acute or chronic on the basis of the onset of symptoms, or as stable or unstable in consideration of a patient's ability to bear weight on the affected limb. In cases of relevant deformities, the architecture of the proximal femur is grossly altered, leading to femoroacetabular impingement and premature development of secondary osteoarthritis of the hip. Various corrective osteotomies have been proposed to restore proximal femoral geometry, but only subcapital osteotomies can correct the pathological femoral anatomy. A minimally invasive anterior approach is an attractive alternative to achieve capital realignment. Using this technique, it is possible to realize cuneiform wedge resection at the subcapital level without violating femoral head vascular supply and avoiding hip dislocation. This video shows the surgical technique of cuneiform wedge osteotomy through a minimally invasive anterior approach without hip dislocation for the treatment of moderate to severe slipped capital femoral epiphysis. Restoration of proximal femoral anatomy is crucial in the treatment of moderate to severe slipped capital femoral epiphysis and subcapital cuneiform wedge resection. When removing the pathologic tissue of the proximal femoral metaphysis, a meticulous surgical technique is essential because the posteromedial cortical must be preserved. After cuneiform wedge resection, anatomical reduction can be easily obtained without tightening the posterior retinacular vessels because of the slight shortening of the femoral neck.

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