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Flexion-Valgus Intertrochanteric Osteotomy for Late-Slipped Capital Femoral Epiphysis Deformity

  • H. Kerr Graham
  • Benjamin J. Shore
  • Simon P. Kelley
Chapter

Abstract

Osteotomy of the proximal femur has been used to correct deformity associated with slipped capital femoral epiphysis (SCFE) for more than 50 years. Southwick described an osteotomy “through the lesser trochanter” in 1963 and reported his results in later publications. Current concepts are similar to the flexion osteotomy in the intertrochanteric region, described by Imhauser in 1973. The principal indications are for the management of moderate to severe, symptomatic deformity of the proximal femur, after healing of SCFE. The components of flexion-valgus intertrochanteric osteotomy (FVIT) for SCFE deformity include combinations of flexion and valgus. Biomechanical modelling by Rab, axial imaging and clinical studies support flexion as being the key component of deformity correction with a small degree of valgus usually required. The evolution of fixation for FVIT in SCFE has included simple plates, compression plates, blade plates and locking plates. Accompanying procedures may include surgical hip dislocation (SHD) and additional surgery for femoro-acetabular impingement (FAI) at the time of FVIT or as a staged procedure. FVIT for moderate to severe deformity of the proximal femur after healing of a SCFE is a technically demanding procedure. However, FVIT can relieve pain, improve gait and function and preserve the native hip until a more suitable age for arthroplasty.

Keywords

Slipped capital femoral epiphysis Flexion-valgus intertrochanteric osteotomy (FVIT) Blade plate Locking plate Femoro-acetabular impingement 

References

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Suggested Readings

  1. Mac Lean SB, Evans S, O’Hara JN. A comparison of reversed locking compression-distal femoral plates and blade plates in osteotomies for young adult hip pathology. Hip Int. 2013;23(6):565–9.CrossRefGoogle Scholar
  2. Sangeux M, Passmore E, Gomez G, Balakumar J, Graham HK. Slipped capital femoral epiphysis, fixation by single screw in situ: a kinematic and radiographic study. Clin Biomech (Bristol, Avon). 2014;29(5):523–30.CrossRefGoogle Scholar
  3. Schai PA, Exner GU, Hänsch O. Prevention of secondary coxarthrosis in slipped capital femoral epiphysis: a long-term follow-up study after corrective intertrochanteric osteotomy. J Pediatr Orthop. 1996;5(3):135–43.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • H. Kerr Graham
    • 1
  • Benjamin J. Shore
    • 2
  • Simon P. Kelley
    • 3
    • 4
  1. 1.Department of Orthopaedic Surgery (NHMRC CP-CRE)Royal Children’s HospitalParkvilleAustralia
  2. 2.Department of Orthopaedic SurgeryHarvard Medical School, Boston Children’s HospitalBostonUSA
  3. 3.Department of SurgeryUniversity of TorontoTorontoCanada
  4. 4.The Hospital for Sick ChildrenTorontoCanada

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