Subcapital Osteotomy

Slipped capital femoral epiphysis (SCFE) is classified as unstable if the patient has such severe pain that walking is impossible, even with crutches, regardless of the duration of the symptoms. Treatment of unstable SCFE is more complicated than stable SCFE because of the risk of damage to the blood supply to the capital femoral epiphysis and subsequent development of osteonecrosis of the femoral head. The goals of unstable slipped capital femoral epiphysis (SCFE) treatment include preventing further slippage of the epiphysis through the closure of the growth plate, avoiding the occurrence of osteonecrosis, and restoring unimpaired hip function. Treatment of a stable SCFE with in situ fixation alone leads to femoroacetabular impingement (FAI) and acetabular cartilage damage, especially in moderate and severe deformities. Hence, for stable SCFE and hips that healed after SCFE with a residual deformity, the treatment should be focused on restoring the proximal femoral anatomy to avoid FAI and the associated chondral pathology. The modified Dunn subcapital realignment using the surgical hip dislocation approach is an excellent alternative for treating unstable and stable SCFE. Dissection of the retinacular flap supplying the blood flow to the femoral head permits assessment and protection of the vessels while complete restoration of the proximal femoral anatomy is achieved.