[Treatment of acute slips and clinical results in slipped capital femoral epiphysis].
In looking at the pathoanatomy of slipped capital epiphysis, it is important to appreciate that the articular cartilage ruptures at the level of the physis as the articular cartilage also covers part of the femoral neck metaphysis. As a consequence, smoothness is lost and already with mild slips the irregularities may injure the acetabular cartilage structures and may cause tears of the labrum. Principally therefore an open revision and restoration of the anatomy as perfectly as possible is needed. The technique for open reduction was developed by Dunn in 1964 and then refined by Ganz in 1997 applying new anatomical vascular studies. However, the long-term data on the "conservative" approach of only using transfixation to avoid further slipping show relatively good results and long-term studies of a more aggressive open approach will be needed to show evidence of further improvement. For the more severe cases, restoration of the correct anatomy by open reduction or improved axial relationships by more distant osteotomies have already been proven to give better results. Besides the extent of the slip, it is important to consider whether the slip is acute or chronic or acute and chronic. So far there are no data showing that the surgical treatment of slipped capital femoral epiphysis must be made on an emergency basis. However, prevention of further slips, e.g., by supine transport, is to be considered an emergency.
Exner
G U
GU
Balgrist, Orthopädische Universitätsklinik Zürich, Switzerland. guexner@balgrist.unizh.ch
Schai
P A
PA
Nötzli
H P
HP
D000293:Adolescent; D001863:Bone Screws; D001864:Bone Wires; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery; D002648:Child; D004839:Epiphyses, Slipped / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005270:Femur Head / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D010027:Osteotomy / Q000379:methods; D012422:Rupture, Spontaneous