A Simple Modified Technique for In-Situ Screw Fixation in Slipped Capital Femoral Epiphysis

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Skeletal imaging

Background:

• In-situ pinning is a standard treatment for slipped capital femoral epiphysis (SCFE).
• Existing techniques carry inherent complications.
• A modified in-situ screw fixation technique on a radiolucent table is proposed to mitigate these risks.

Purpose of the Study:

• To describe and evaluate a modified in-situ screw fixation technique for SCFE.
• To assess the safety and accuracy of this modified technique.
• To compare outcomes with existing methods.

Main Methods:

• Analysis of 60 consecutive hips undergoing modified in-situ fixation for SCFE or prophylactic fixation.
• Categorization of femoral head into three zones (A, B, C) for screw placement analysis.
• Measurement of screw angle and tip-to-articular surface distance in AP and lateral views.
• Assessment of interobserver agreement and complications at minimum one-year follow-up.

Main Results:

• Over 91% of screws were placed in zone-A (central) in both AP and lateral views.
• No screws were placed in zone-C (peripheral).
• Average screw deviation was <15° (AP) and <7° (lateral).
• Mean screw tip to articular margin distance was 5.15 mm (AP) and 6.15 mm (lateral).
• High interobserver agreement (0.8) and no intraoperative or postoperative complications (avascular necrosis, chondrolysis, etc.) were observed.

Conclusions:

• Modified in-situ pinning on a radiolucent table is a safe and advantageous procedure for SCFE.
• This technique enhances the safety and accuracy of screw fixation.
• The method demonstrates excellent screw placement and avoids complications.