title: Management outcome and the role of manipulation in slipped capital femoral epiphysis.
abstract: OBJECTIVE
  To examine and compare treatment outcomes for slipped capital femoral epiphysis (SCFE).
  
  
  METHODS
  24 patients with acute or acute-on-chronic SCFE underwent preoperative traction, 13 of them followed by in situ screw fixation (group A), and the remaining 11, manipulation with screw fixation (group B). Their treatment outcomes (according to the Aadalen criteria) and complications were compared.
  
  
  RESULTS
  There were 2 treatment failures and one poor outcome in patients with acute SCFE (2 had avascular necrosis and one had slight pain with mild limitation of hip movement). The risk of developing avascular necrosis was significantly higher in patients with acute rather than acute-on-chronic or chronic slips. No significant differences were evident between groups A and B with regard to age, sex, ethnicity, outcomes, and preoperative and postoperative changes in the Southwick headshaft angle.
  
  
  CONCLUSIONS
  Patients with acute or acute-on-chronic SCFE can be safely managed with straight-leg traction for up to 6 days, followed by in situ screw fixation without manipulation. Manipulation is not recommended in such slips, due to a higher avascular necrosis risk.
authors.affiliation: Department of Orthopaedic Surgery, Kandang Kerbau Women's and Children's Hospital, Singapore. lim.yi.jia@singhealth.com.sg
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lim
authors.forename: K S
authors.initials: KS
authors.lastname: Lam
authors.forename: K Bl
authors.initials: KB
authors.lastname: Lim
authors.forename: A
authors.initials: A
authors.lastname: Mahadev
authors.forename: E H
authors.initials: EH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D004839:Epiphyses, Slipped / Q000628:therapy*; D005260:Female; D005270:Femur Head / Q000473:pathology*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D018709:Statistics, Nonparametric; D016896:Treatment Outcome