Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics

Rutgers-New Jersey Medical School

My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure

Program.

I have no conflicts.

•Severe SCFE = worse prognosis

•Altered biomechanics

•Femoro-Acetabular impingement

•Various realignment strategies

•Percutaneous Osteotomy / Ilizarov

Modified Southwick osteotomy Half-pins in proximal / distal fragments Femoral arches orthogonal to each fragment Percutaneous multiple-drill hole osteotomy Triplanar correction Reposition arches parallel to each other Connect arches with threaded rods Fine tune with conical washers

1.8 mm wire Femoral Arches 4.8 mm drill bit HA coated pins Osteotomes Threaded rods Conical washers

Radiolucent table Supine Bump under buttock

Orthogonal Femoral Arches

Frontal view

Percutaneous multiple drill hole osteotomy with correction

1. Internal Rotation 2. Anterolateral Translation 3. Flexion and Abduction

Threaded rods / Conical washers Both arches almost parallel

• Follow up: 23 (6 – 49) months

• Time in OR: 143 (118 – 210) mins

• Blood loss: 61 (50 – 100) cc

• Hospital stay: 2.4 (2 -4) days

• Time in fixator: 18 (14 – 23) weeks

Results: Range of Motion

ROM (deg) Pre-op Post-op Diff p value

Flexion 74 106 33 0.02 (20 – 90) (95 – 130)

IR -5 17 24 0.007

(-33 – 15) (5 – 40)

ER 71 41 29 0.0003

(25 – 90) (5 – 68)

Abduction 29 36 12 0.23

(14 – 50) (25 – 45)

Results: Radiographic

Pre-op Post-op Diff p value

AP Head Shaft 112 134 22 0.004 Angle (deg) (84 – 138) (117 – 154)

Lat Head Shaft 72 15 57 <0.0001

Angle (deg) (57 – 101) (-2 – 26)

LLD (cm) 1.8 1.8 1.2 0.80

(0.6 – 2.9) (0 - 4)

Postop Scanogram

Before osteotomy

After removing external fixator

Transient chondrolysis 1 Fixation related problems 0 Deep infection 0 AVN 0 Refracture 0 Unplanned OR 0

Langenskiold

Pauwels

Borden

0

20

40

60

80

100

120

140

Preop Post op Final F/u

74°Pre op 33°Post op (∆=41°)

0

20

40

60

80

100

120

140

160

Preop Post op Final F/u

86°Pre op 137°Post op (∆=51°)

-20

-15

-10

-5

0

5

10

15

20

25

30

Preop Post op Final F/u

- 6 mm Pre op + 11mm Post op (∆=17 mm)

Safe Effective in large patients Accurate / sustained correction Minimize blood loss Avoids further shortening May do lengthening as needed Early mobilization

Need to be familiar with ex fix Time in fixator Pin related issues Impact on future surgery ? Short follow up

Percutaneous technique appears safe and effective in correcting pediatric proximal femoral deformities associated with: SCFE

Developmental Coxa Vara

Painful Dislocated Hips in CP

My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure

Program.

I have no conflicts

My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure

program.

My disclosure is: