Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis: Surgical Technique.

Abstract

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. Following anesthesia induction, position the patient and assess the physeal stability fluoroscopically to determine the need for a reduction. Place a 3.2-mm threaded guidewire from the anterolateral aspect of the femur to provide initial stability of the slipped epiphysis. Insert a cannulated 7.0-mm stainless steel screw over the guidewire to a point just past the physis. 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. If a perfusion pressure and waveform cannot be obtained, perform decompression of the hip capsule by either aspiration or capsulotomy. Following the capsulotomy, reinsert the ICP probe and reassess the epiphyseal perfusion. Once epiphyseal blood flow can be confirmed, reintroduce the guidewire to its previous depth and advance the screw to the final measured depth. 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.