Purpose: Unstable slipped capital femoral epiphysis (SCFE) can result in a high incidence of avascular necrosis (AVN) and residual deformity leading to femoral acetabular impingement (FAI). Surgical hip dislocation with open reduction and internal fixation (ORIF) has been proposed as a surgical method to avoid or limit these complications.

Method: A prospective consecutive series of patients who presented with an unstable SCFE and underwent a surgical hip dislocation/ORIF were reviewed. The procedure entails urgent arrival to the operating room, a surgical dislocation procedure to gain full access to the proximal femur, removal of the posterior and medial callus with necessary shortening of the femoral neck to anatomically reduce the femoral head without tension on the vasculature.

Results: There are 15 patients in this series with a minimum of 1 year follow-up. Average age was 12.5 years at the time of presentation, 10 males and 5 females. Surgical dislocation was performed at a mean of 29.1 hours from the traumatic event. The surgical procedure averaged 135.5 minutes, with an average blood loss of 220ccs. Fourteen patients have no evidence of AVN while one patient with AVN was due to a surgical step not performed in the remaining hips. Normal anatomic position of the epiphysis was achieved in 11 of 15 patients while the remaining 4 had mild posterior angulation averaging 6.2 degrees. Average hip flexion was 114°, internal rotation 22°, external rotation 35°. Two patients required reoperation for broken screws (both 4.5mm cannulated screws).

Conclusion: Surgical dislocation with removal of medial and posterior callus and shortening of the femoral neck can reduce the femoral head to a near anatomic position to avoid FAI and appears to result in a very low incidence of avascular necrosis. A single patient with AVN was the result of technical issue which can be avoided.

Purpose: The Lenke classification has established criteria which designate the proximal thoracic (PT) curve as structural (Lenke 2). However, this classification may overestimate the necessity to include the proximal thoracic curve in the fusion construct. The objective of this study was to compare the incidence of fusing the PT curve for true Lenke 2 curve patterns, comparing a time period when the classification was not utilized and when it was first used.

Method: A retrospective review of a consecutive series of patients with adolescent idiopathic scoliosis (AIS) at a single institution from 1996–2000 (early group) and from 2002–2004 (late group) were reviewed. The curves were all classified by the Lenke classification retrospectively. Patients were also grouped into those who have had inclusion of the PT curve (+PT fusion) and those who did not (−PT fusion).

Results: There were 44 in the early group and 33 in the late group. There were no differences in the early and late groups with respect to age (14.3 vs. 14.4yrs), gender (79.5% vs. 69.7% female), BMI (21.7 vs. 22.4kg/cm2), the preoperative PT magnitude (40.0° vs. 38.6°), curve flexibility (16.0% vs. 14.5%), the main thoracic (MT) magnitude (63.4° vs. 62.7°), T1 tilt (7.3° vs. 5.2°), pre-operative clavicle angle (1.0° vs. −0.2°), and preoperative shoulder height (1.2 vs. −0.8mm. The early group had fusion of the PT less often (36% vs. 57%)(p< 0.05) which resulted in a greater residual PT curve (26.5 vs. 22.2°), MT curve (33.8 vs. 27.8°), and a greater clavicle angle (4.6 vs. 2.5°)(p< 0.05). At two years the PT continued to be significantly greater in the early group (28.6 vs. 22.8°)(p< 0.05), however T1 tilt (8.8 vs. 8.1°), clavicle angle (1.3 vs. 1.0°), and shoulder height (3.5 vs. 4.7mm) were the same.

Conclusion: The application of the Lenke classification system for AIS increases the likelihood of instrumenting a PT curve resulting in improved postoperative PT curve magnitude. However, similar shoulder balance, T1 tilt and clavicle angle were seen compared between groups. The classification system should be used to guide decision making, however, other parameters should be evaluated when deciding when to instrument a PT curve.