Technical Note: Bone Marrow Aspirate Needle to Assist In-Situ Screw Fixation of Slipped Capital Femoral Epiphysis.

Slipped capital femoral epiphysis (SCFE) is characterized by posterior and inferior displacement of the capital femoral epiphysis in relationship to the metaphysis. Although universally accepted as a treatment modality for SCFE, in-situ pinning may be technically challenging in obese adolescents with large body habitus. Adequate screw position is important to achieve stabilization of the epiphysis and to allow closure of the growth plate. During the surgical procedure of in-situ pinning, it is crucial to obtain not only a perfect starting point but also an appropriate trajectory. However, creating a perfect entry point in obese patients with a large thigh may be troublesome. Often the pediatric orthopedic surgeon is faced with intraoperative challenges for screw placement including, but not limited to, the guidewire skiving down anteriorly on the metaphysis, and bending of the guidewire due to a large body habitus when the hip is positioned to obtain a lateral radiograph. We have used a bone marrow biopsy needle as an adjunct for placement of the guidewire during in-situ pinning for SCFE. This technical trick describes our method of using a bone marrow biopsy needle to ease the placement of a guidewire during in-situ pinning.