Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ
CPT4 code
Name of the Procedure:
Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ
Common Names: SCFE Pinning, Hip Pinning, In Situ Fixation
Medical Terms: Slipped Capital Femoral Epiphysis Pinning, In Situ Fixation of SCFE
Summary
Slipped femoral epiphysis pinning is a surgical procedure to stabilize the hip joint when the femoral head slips out of its normal position. Pins or screws are inserted to hold the femoral head in place, preventing further slippage and correcting the deformity.
Purpose
This procedure addresses a condition known as slipped capital femoral epiphysis (SCFE), where the femoral head slips away from the thighbone at the growth plate. The goal is to stabilize the hip, relieve pain, and prevent further slippage, promoting proper hip function and growth.
Indications
- Persistent hip or knee pain in children and adolescents.
- Limited hip movement.
- Diagnosis of SCFE via imaging techniques. Patient criteria:
- Typically affects children and adolescents aged 10-16.
- Higher risk in overweight children or rapid growth periods.
Preparation
- Patients are advised to fast for several hours before surgery.
- A pre-surgical assessment includes physical exams and imaging tests like X-rays or MRI.
- Adjustments to current medications may be required, and blood tests may be conducted.
Procedure Description
- Anesthesia: The patient is put under general anesthesia for the procedure.
- Positioning: The patient is positioned on the operating table to access the hip joint.
- Incision: A small incision is made in the hip area.
- Pin Insertion: Using imaging guidance (like fluoroscopy), one or more pins or screws are inserted through the femoral neck into the femoral head to stabilize it.
- Closure: The incision is closed with sutures or staples, and a dressing is applied.
Tools and Equipment:
- Imaging technology (fluoroscopy)
- Surgical pins or screws
- Standard surgical instruments
Duration
The procedure typically takes about 1 to 2 hours.
Setting
Performed in a hospital operating room or a surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Radiologic technician (for imaging guidance)
Risks and Complications
Common Risks:
- Infection at the surgical site
- Minor bleeding
- Temporary pain and swelling
Rare Complications:
- Damage to surrounding nerves or blood vessels
- Deep vein thrombosis (DVT)
- Failure of fixation, requiring additional surgery
- Potential for growth disturbances in the femoral head
Benefits
- Stabilizes the hip joint and prevents further slippage
- Relieves pain and improves mobility
- Promotes normal hip function and growth Expected benefits can typically be seen within weeks as healing progresses.
Recovery
- Hospital stay of 1-2 days post-surgery.
- Limited weight-bearing on the affected leg, usually requiring crutches.
- Follow-up appointments for X-rays and to monitor healing.
- Physical therapy may be recommended.
Alternatives
- Non-surgical management (e.g., bed rest, activity modification), often insufficient for severe cases.
- Open reduction and internal fixation, a more invasive alternative. Pros and Cons:
- Non-surgical may delay required surgical intervention; more suited for mild cases.
- Open reduction allows for a more direct approach but involves a larger incision and potentially longer recovery time.
Patient Experience
During the procedure, the patient won't feel anything due to general anesthesia. Post-procedure, some discomfort and swelling are typical, manageable with pain medication. The use of crutches and limited mobility will be necessary in the early recovery phase. Most patients can return to normal activities in a few months.