• INTRODUCTION
    • Intraoperative monitoring of epiphyseal perfusion in slipped capital femoral epiphysis (SCFE) is a procedurally simple and readily accessible percutaneous technique to accurately guide decision-making and help to prevent osteonecrosis.
  • STEP 1 PATIENT PREPARATION AND POSITIONING
    • Following anesthesia induction, position the patient and assess the physeal stability fluoroscopically to determine the need for a reduction.
  • STEP 2 GUIDEWIRE PLACEMENT
    • Place a 3.2-mm threaded guidewire from the anterolateral aspect of the femur to provide initial stability of the slipped epiphysis.
  • STEP 3 INITIAL SCREW INSERTION
    • Insert a cannulated 7.0-mm stainless steel screw over the guidewire to a point just past the physis.
  • STEP 4 PREPARATION AND INSERTION OF THE ICP PROBE
    • Once the screw has been inserted to obtain provisional stability of the physis, remove the guidewire and insert a sterile ICP probe down the screw shaft to assess the epiphyseal perfusion.
  • STEP 5 HIP DECOMPRESSION
    • If a perfusion pressure and waveform cannot be obtained, perform decompression of the hip capsule by either aspiration or capsulotomy.
  • STEP 6 EPIPHYSEAL PERFUSION REASSESSMENT
    • Following the capsulotomy, reinsert the ICP probe and reassess the epiphyseal perfusion.
  • STEP 7 FINAL SCREW ADVANCEMENT
    • Once epiphyseal blood flow can be confirmed, reintroduce the guidewire to its previous depth and advance the screw to the final measured depth.
  • RESULTS
    • Utilizing this technique over a 5-year period, >35 patients were treated with the described technique, and 23 of them, including 29 hips, were included in our referenced prospective study3.