3 The procedure
3.1 Open reduction of slipped capital femoral epiphysis aims to relocate the capital femoral epiphysis and centre its position in the acetabulum, while minimising the risk of avascular necrosis by preserving blood vessels to the epiphysis.
3.2 The procedure can be done in a variety of ways (some with eponymous names such as the Dunn, Bernese and Ganz approaches). Most involve a cuneiform (wedge‑shaped) osteotomy of the femoral neck. An important point of the technique is whether or not the hip is surgically dislocated during the procedure. This is done to create an extended retinacular flap, to provide extensive subperiosteal exposure of the circumference of the femoral neck, and so protect the blood supply to the epiphysis, minimising the risk of avascular necrosis.
3.3 With the patient under general anaesthesia, an anterior or anterolateral approach is used to expose the hip and a capsulotomy is done; at this stage, the hip may be dislocated surgically. A section of bone is then removed from the metaphysis of the femoral neck. Reduction is done by adducting and rotating the limb, realigning the epiphysis in its normal position in the acetabulum. The realigned femoral neck is then secured with 1 or 2 cannulated screws or Kirschner wires.