27178 Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning

Name of the Procedure:

Open Treatment of Slipped Femoral Epiphysis (SFEP); Closed Manipulation with Single or Multiple Pinning

Summary

This procedure involves the surgical treatment of a slipped femoral epiphysis, a hip condition in children where the ball at the head of the femur slips off in a backward direction. The surgery includes manipulating the femur back into place and securing it with pins to stabilize the bone.

Purpose

Medical Condition:

Slipped Femoral Epiphysis (SFE), a common hip disorder in adolescents.

Goals:

To stabilize the femoral head, prevent further slipping, relieve pain, and restore normal hip function.

Indications

• Persistent hip, thigh, or knee pain
• Limping or an inability to bear weight on the affected leg
• Sudden onset of symptoms indicating a more severe slip
• Diagnosis confirmed through imaging studies (X-rays, MRI)

Preparation

• The patient may be instructed to fast for a certain period before the procedure.
• Medications may need to be adjusted or temporarily discontinued.
• Pre-procedure diagnostic tests may include blood tests, X-rays, or an MRI to assess the severity of the slip.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is asleep and pain-free.
2. Closed Manipulation: The surgeon gently manipulates the femoral head back into its correct position.
3. Pinning: One or more pins are inserted to hold the femoral head in place. These pins may be inserted through the skin using a small incision, guided by imaging technology such as fluoroscopy.
4. Closure and Dressing: The small incision is closed with sutures or staples, and a sterile dressing is applied to the wound.

Tools and Equipment:

• Surgical pins/screws
• Fluoroscopy machine for imaging guidance
• Surgical instruments for manipulation and pin insertion

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Radiologic Technologist (for imaging)

Risks and Complications

• Infection at the incision site
• Pin migration or failure
• Damage to surrounding blood vessels or nerves
• Avascular necrosis (loss of blood supply to the femoral head)
• Continued slippage or deformity

Benefits

• Stabilization of the femoral head
• Relief from pain
• Improved hip function
• The potential to prevent further complications and deformities

Recovery

• Immediate post-operative care involves monitoring in a recovery room.
• Pain management may include medications.
• The patient may need to use crutches or a walker for a few weeks.
• Physical therapy may be recommended to restore strength and mobility.
• Follow-up appointments to monitor healing and pin placement.
• Full recovery can take several months, with activity restrictions gradually lifted as healing progresses.

Alternatives

• Non-Surgical Management: Includes activity restriction and medication, but may not be effective for severe slips.
• Open Reduction and Internal Fixation: For severe cases where closed manipulation is not possible.

Pros and Cons:

• Non-Surgical Management: Less invasive but potentially less effective in severe cases.
• Open Reduction and Internal Fixation: More invasive with potentially longer recovery but may be necessary for severe slips.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, there might be some discomfort or pain managed with medications. The patient may experience temporary limitations in mobility and will need to follow specific care instructions to ensure proper healing. Pain and discomfort should gradually improve as recovery progresses.