Child Orthopedics

Frequently Asked Questions

Our 12-year old son had his hip pinned to correct a problem called SCFE. It didn't work and now he has to have an osteotomy. What happens if this operation doesn't work?

Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip in young teenagers. In this condition, the growth center of the hip (the capital femoral epiphysis) slips backwards on the top of the femur (the thighbone). If untreated, this can lead to serious problems in the hip joint later in life.

As with your son, the first step is to insert a long screw to stop the epiphysis from slipping further. A special X-ray machine called a fluoroscope is used. The fluoroscope allows the surgeon to see an X-ray image on a TV monitor while doing the surgery. In this way, the surgeon is able to place a screw into the epiphysis using a small incision in the side of the thigh.

If this doesn't work, greater deformity can occur in the hip. Another operation may be needed to relign the hip and keep the problem from getting worse. In such cases, the most commonly performed operation is the reconstructive or wedge osteotomy.

A wedge-shaped piece of bone is removed and the two remaining pieces of bone are moved closer together. Screws are used to hold everything in place. Exactly where to take the bone from the femur is a matter of debate. Removing any amount of bone alters the way the hip muscles attach and function.

Other problems that can occur include avascular necrosis (AVN). AVN refers to a loss of blood supply to the head of the humerus. The bone can start to die from a lack of oxygen and nutrients. Taking the wedge piece of bone from down lower in the femur can eliminate this problem but increases the risk of muscle imbalance. Each child is evaluated individually to find the best choice for him or her.

Deformity. In Clinical Orthopaedics and Related Research. January 2007. No. 454. Pp. 163-168.

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