A Simple Modification for In Situ Pinning in Slipped Capital Femoral Epiphysis on a Radiolucent Table to Reduce Operative Time and Radiation Exposure.

Abstract

In situ pinning is the mainstay treatment method in mild and moderate slipped capital femoral epiphysis (SCFE). Despite successful outcomes, some technical difficulties may be encountered during surgery, typically in overweight SCFE patients. The aim of the study is to compare the use of a bone marrow biopsy needle system to navigate the cannulated screw guidewire with the traditional in situ pinning technique. We retrospectively reviewed patients undergoing in situ pinning for stable mild-moderate SCFE at 2 different institutions between 2022 and 2024. Included patients were divided into 2 groups according to whether the cannulated screw guidewire was navigated by a bone marrow biopsy needle system (group 1) or inserted with traditional technique (group 2). Clinical, surgery-related, and radiographic data were then reviewed to compare groups. Thirty-four hips of 28 patients were included (18 hips of 14 patients in group 1, 16 hips of 14 patients in group 2) with a mean age of 12±1.6 (9 to 15) years. There was no significant difference between groups in age, sex, side, body mass index, Southwick angle, acute/chronic ratio, and follow-up duration. Group 1 had significantly shorter operative time (P=0.003) as well as total fluoroscopy images taken (P=0.001) as compared with group 2. There was no difference between groups for screw accuracy in both anteroposterior (P=0.163) and lateral planes (P=0.887). No complication was reported in either group. Using a bone marrow aspirate needle to serve as a cannula for cannulated screw guidewire in order to determine a proper femoral entry point as well as to avoid its bending and breakage throughout the procedure is a cheap and effective modification for in situ pinning of SCFE. It significantly reduced the operative time and radiation exposure as compared with the traditional method. Level III-retrospective comparative study.