SCFE Screw Removal with Coring Reamer

In situ percutaneous pinning of a Slipped Capital Femoral Epiphysis (SCFE) is a safe and effective surgical treatment to prevent deformity progression in children.¹ Contemporary implant options include cannulated fully and partially threaded screws available in stainless steel or titanium. Routine implant removal is controversial, yet some surgeons attempt removal to reduce risk of fracture associated with an increased stress riser, screw irritation, or in preparation for future hip procedures.^2,3,4 Difficulty with hardware removal is well documented in SCFE patients.^4-8 In this article, we describe our technical tips for removal of a stuck 7.3-millimeter cannulated cancellous SCFE screw in a patient who required surgical treatment for chronic symptomatic SCFE deformities. We describe screw removal failure that ultimately required over reaming with a 10mm coring reamer to retrieve the screw. A written and video technical guide is provided for evaluating the opportunities and obstacles of how similar cases can be addressed with success. Key Points: • SCFE screw removal is inherently difficult. • Preoperative planning and the expectation for challenges should be discussed with the surgical team as well as the patient and family. • Use of a coring reamer to remove the screw and surrounding bone en bloc is a viable option. • Bone graft can augment the final defect.