FFEMORAL NECK OSTOTOMY FOR SEVERE SLIPPED UPPER FEMORAL EPIPHYSIS USING THE GANZ APPROACH

Abstract

A prospective study was done on 6 adolescent patients with severe unilateral chronic SCFE who underwent femoral neck cuneiform osteotomies with an antero lateral Ganz approach and subsequent anterior hip dislocation.

Patients with chronic SCFE, open growth plates and Southwick diaphyseal epiphyseal angle of more than 60 degrees were selected. In situ pinning was not possible in these cases due to the severity of the disease and keeping in consideration the concepts of impaction and inclusion as described by Rab. The surgical approach as described by Ganz for impingement syndromes in adults was used. A lateral approach with the patients lying on the side was followed by trochanteric osteotomy, anterior capsulotomy and anterior dislocation of the hip. Metaphyseal cuneiform osteotomies were done on all of the hips. Clinical and radiological assessment was done by the Southwick classification. Additional radiological assessment consisted of the evaluation of correction of anatomy on an AP pelvis. The hips were furthermore assessed for AVN by using bone scans.

This is a short term follow-up. Of the 6 patients 5 did excellently according to the Southwick result score. One patient had only a fair result due to the damage caused by the impingement prior to the corrective osteotomy. None developed AVN.

The management of severe chronic SCFE remains controversial. A single method of management namely pinning in situ can not be used in all degrees of SCFE. Intertrochanteric osteotomies and subtrochanteric osteotomies distort anatomy. It can not be performed for deformities of more than 50 and 70 degrees. Dislocation of the femoral head fascilitates femoral neck osteotomies and can be used safely without the complication of AVN if the Ganz surgical exposure is used.