Epifisiolisi

Significant controversies exist in the literature regarding the best treatment for SCFE. In fact a variety of surgical procedures have been described and they can be divided into fixation in situ, compensatory osteotomies and direct corrections of the deformity at head-neck junction. The first and the second group of procedures have, so far, not gained optimal control over the risk of avascular necrosis or cannot achieve an anatomically aligned epiphysis with normal blood supply; on the contrary the third technique can achieve this target and prevent the residual pistol-grip deformity of the proximal femur, that can lead to anterior impingement, labral pathology and the development of early hip arthritis. Open subcapital reorientation of the epiphysis by surgical dislocation has been described as a safe and effective technique in the recent literature. In this paper the Italian group for hip conservative surgery offers its experience: in different centers 20 SCFEs were treated showing good clinical results and anatomic reorientation of the femoral head. No femoral head necrosis has been reported. These results and the other published papers underline that surgical dislocation and the preparation of an extended retinacular flap offers sufficient advantages in assessing and treating SCFE, and although the technique is demanding, a judicious application provides the prerequisites for a favourable long-term outcome.