CORRECTION OF DEFORMITY AND PREVENTION OF ASEPTIC NECROSIS IN LATE CASES OF SLIPPED FEMORAL EPIPHYSIS

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Abstract
1. The object of treatment of slipped or slipping capital femoral epiphsysis is to maintain or restore painless hip function, with a range of motiots as nearly normal as possible and a minimum of shortening of the extremity. 2. Epiphysiolysis with marked displacement has been treated by open wedge osteotomy with uniformly good results. Aseptic necrosis with osteo-arthritis occurs rarely. The incidence is definitely less than that which follows closed manipulation, and is no greater than that which follows application of a cast without any attempt at reduction. 3. An accurate determination of the degree of slipping is essential. This is possible only with good lateral roentgenograms of the hip. 4. To avoid aseptic necrosis or delayed osteo-arthritis, there must be a minimal amount of damage to the blood supply when the capsule is opened to expose the joint. 5. Wedge resection of the proximal superior portion of the femoral neck should he followed by gentle freeing of the head, just distal to the epiphyseal line. 6. The epiphsyseal plate must be perforated with a gouge and a curette, thus exposing porous cancellous hone on the portion of the head which will be in contact with the prepared neck surface. 7. Great care should be exercised in the reduction to prevent additional injury to the cir(culation of the femoral head, as a result. of needless stretching or tearing of the ligamentum teres or the capsular vessels. The head should be placed in position over the raw bone surface on the top of the neck. 8. Rigid intetnal fixation of the head of the femur to the neck is essential. 9. Early active motion is most desirable, with the hip Protected from weight-bearing until healing is complete. 10. If the follow-up roentgenograms show aseptic necrosis, weight-bearing should be postponed until there is roentgenographic evidence of replacement of the dead bone by creeping substitution.

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