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Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis.

Based on the recognition that even minor slip displacement in patients with slipped capital femoral epiphysis can regularly produce acetabular cartilage damage and early clinical symptoms, subcapital realignment of the epiphysis should be considered, although a substantial risk of osteonecrosis has been reported. A modified surgical technique can be used in which the perfusion of the epiphysis via the medial femoral circumflex artery is actively protected during surgery by executing surgical dislocation of the joint and by developing a soft-tissue flap consisting of the retinaculum and the external rotator muscles. This flap allows mobilization of the epiphysis within the growth plate as well as complete callus resection of the neck without stretching the retinaculum. The dislocation of the head allows manual fixation of the epiphysis while curettage of the residual growth plate is performed, as well as manual reduction of the epiphysis onto the metaphysis under visual control of the retinaculum. With the head dislocated, any uncontrolled manipulation of the leg will result in less risk to the integrity of the retinaculum than would be the case if the head was reduced in the socket.