Purpose: Treatment of femoral epiphysiolysis with major displacement remains a controversial subject. Open repositioning of the epiphysis via a lateral approach as proposed by Dunn allows nearly anatomic restitution but with a high rate of complications. We report our experience with open repositions via an anterior approach which has been more reliable in our hands.

Material and methods: During the last decade, we operated nine hips for epiphysiolysis with major displacement, using the anterior approach to spare the medial circumflex artery. External reduction was not attempted. Preoperative and residual displacement were evaluated using the Southwick technique and according to the position of the femoral head in relation to the Klein line. Early after surgery, a bone scintigram was obtained for all hips. We followed these patients to bone maturity, with a mean follow-up of four years.

Results: The early postoperative scintigrams did not reveal any case of insufficient uptake in the femoral head. Mean correction was 43° on the lateral view, with a mean preoperative displacement of 72°. Mean residual displacement after surgery was 23°. After repositioning, position of the epiphysis in relation to the Klein line was not significantly different from the position observed on the healthy side. Postoperatively, leg length discrepancy was 1 cm. At last follow-up, there have been no signs of osteonecrosis, chondrolysis or osteoarthritic degeneration. At mean 44 months follow-up, all of the patients have unlimited activities, including sports. Only one patient complained of mild climate-related pain.

Discussion: Compared with the lateral approach with trochanterotomy as proposed by Dunn, we have found the anterior approach technically easier and more reliable in terms of protecting the epiphyseal blood supply. The correction obtained, voluntarily preserving a certain degree of under-correction, associated with resection of a portion of the neck enables repositioning without risking vessel stress. Use of a stable internal fixation which allows early mobilisation would be an explanation of the absence of postoperative chondrolysis.

Conclusion: These results appear to be sufficiently encouraging to advocate this technique previously described by PH Martin in 1948.

Introduction and Objectives: Though not a common disease, proximal femoral epiphysiolysis (PFE) is one cause of premature degeneration of the joint. The aetio-pathogenesis is unknown. The challenge with this disorder is making an early diagnosis. This study presents the experience of our center in surgical treatment of this condition.

Materials and Methods: This is a retrospective study of 27 cases of PFE in 25 patients treated between 1990 and 1998, analyzing therapeutic management at the time of presentation and clinical, radiographic, and subjective findings in the short and medium terms. Based on duration of symptoms, the disorder is classified as acute, chronic, or subacute. Degree of displacement is classified as mild (less than 30%), moderate (30–60%), and severe (great than 60%). Dunn and Angel’s criteria were used for clinical evaluation, as modified for this study. Radiographic follow-up was based on the capitodiaphyseal Southwick angle, measuring the amount of correction postoperatively and in the medium-term examination.

Results: There were 17 males (63%) and 10 females (37%). Average age was 12.5 years. The right side was affected in 10 cases (40%), the left in 13 (52%), and both sides in 2 (8%). The majority of patients presented with chronic epiphysiolysis (44%) with mild displacement (74%). In most cases, surgical intervention consisted of in situ fixation with or without a previous attempt at reduction, based on the degree of displacement on an orthopaedic table with scope guidance. Fixations were performed primarily with Kirschner wire or cannulated screws. Preoperative complications included incomplete reduction of the fracture, breakage of the Kirschner wire, and superficial infection of the surgical wound.

Discussion and Conclusions: The worst results were seen in patients with epiphysiolysis with severe initial displacement and in patients who developed aseptic necrosis of the femoral head or chondrolysis. Intra-articular penetration with this material and valgus positioning should be avoided. At present, we are doing the fixation of the epiphysis using a single cannulated screw. We believe early detection of the process is very important in cases featuring gradual displacement.

Aim: Can comparable results be obtained regarding the postoperative improvement of range of motion using ßexionosteotomy alone in comparison to the three-dimensional corrective osteotomy. Material and Methods: 16 patients after SCFE were analyzed (7 female, 9 male). A computer program for simulation of movement and osteotomy developed by the authors, served for study execution. According to 3D-reconstruction of the computer tomography data the physiological range was determined by ßexion, abduction and internal rotation. The three-dimensional osteotomy was compared with the onedimensional ßexionosteotomy. Both inter-trochanteric osteotomy techniques were simulated and the improvements of the movement range were assessed and compared. Results: The average slipping and thus correction angles measured inferior 25.5¡ (range: 7.5¡–51.0¡) and posterior 52.0¡ (range: 29.0¡– 78.5¡). After the simulation of osteotomy by Southwick the angle of ßexion was 61.3¡ (improvement: 41.4¡), of abduction 60.3¡ (improvement: 42.9¡) and interior rotation of 70.1¡ (improvement: 52.6¡). The ßexionsosteotomy after Grifþth achieved a ßexion of 66.7¡ (improvement: 46.8¡), an abduction of 41.1¡ (improvement: 23.7¡) and an internal rotation of 57.4¡ (improvement: 40.0¡). Conclusion: The improvement of the free movement range after ßexion osteotomy is comparable, with three-dimensional osteotomy after Southwick with the exception of the abduction angle.

In Clinical practice damage to the growth plate is usually caused by trauma. In neonates and infants, sepsis involving the growth plate may lead to very severe deformities as well as limb length discrepancy. The management for the child with physeal growth arrest depends on the age of the child, the site and the extent of involvement of the physis. The assessment of the extent of involvement of the physis can be made by plain x-rays, tomograms and magnetic resonance imaging. In younger children epiphysiolysis with or without an osteotomy is usually performed. In cases where is there is severe limb length discrepancy additional treatment with limb lengthening is carried out. Children towards the end of growth benefit from a corrective osteotomy. Hemichondrodiatasis is not recommended in younger children as there is a risk of physeal fracture leading to further growth arrest. However it can be used for selected cases towards the end of growth. Epiphysiolysis with the use of interposition materials such as fat, silastic or cement has been shown to be successful for bony bars occupying less than 30 % of the entire physis. In cases where the physeal injury is more extensive recent experimental work has shown that the use of tissue engineering techniques involving the transfer of cultured chondrocytes or mesenchymal stem cells may produce better results than conventional methods