27181 Open treatment of slipped femoral epiphysis; osteotomy and internal fixation

Name of the Procedure:

Open Treatment of Slipped Femoral Epiphysis

• Also known as: Osteotomy and Internal Fixation for Slipped Capital Femoral Epiphysis (SCFE)

Summary

Open treatment for slipped femoral epiphysis is a surgical procedure that realigns the femoral head (thigh bone) and stabilizes it using screws or other hardware. This surgery is essential when the growth plate (epiphysis) slips out of place, usually in adolescents.

Purpose

The procedure addresses Slipped Capital Femoral Epiphysis (SCFE), a condition where the femoral head slips off the neck of the femur. The primary goals are to realign the femoral head, stabilize it to prevent further slippage, alleviate pain, and restore normal hip function.

Indications

• Persistent hip or knee pain.
• Limp or inability to bear weight on the affected leg.
• Diagnosis confirmed by X-rays or other imaging.
• Typically performed in adolescents experiencing growth spurts.

Preparation

• Fasting as directed (usually 6-8 hours before surgery).
• Adjustments to current medications as instructed by the doctor.
• Pre-surgical assessment including physical examination and imaging studies (X-rays, MRI).

Procedure Description

1. Anesthesia is administered (usually general anesthesia).
2. An incision is made near the hip to access the femur.
3. The slipped femoral head is realigned (osteotomy).
4. Internal fixation is achieved using screws or pins to stabilize the bone.
5. The incision is closed with sutures or staples.
6. A sterile dressing is applied to the surgical site.

Duration

The procedure typically takes about 1.5 to 2 hours.

Setting

Usually performed in a hospital's surgical suite under sterile conditions.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site.
• Blood clots.
• Damage to surrounding blood vessels or nerves.
• Hardware-related issues (e.g., screw loosening).
• Slippage recurrence.
• Leg length discrepancy.

Benefits

• Pain relief.
• Improved hip function and stability.
• Reduced risk of further slippage and complications.
• Potential for normal growth and development of the affected leg.

Recovery

• Hospital stay for 1-3 days post-surgery.
• Pain management with medications.
• Physical therapy to regain strength and mobility.
• Instructions on weight-bearing restrictions.
• Follow-up appointments to monitor healing and hardware position.
• Full recovery may take several months.

Alternatives

• Non-surgical management (limited to mild cases) involving activity modification and monitoring.
• In situ fixation without realignment for less severe cases.
• Pros and cons: Non-surgical management has a higher risk of progression, while in situ fixation is less invasive but may not correct anatomical misalignment.

Patient Experience

• Under general anesthesia during the procedure (no pain felt).
• Post-surgical pain managed with medications.
• Discomfort and limited mobility initially, improving with time and physical therapy.
• Detailed post-operative care instructions to enhance recovery and minimize complications.