title: Urgent reduction, fixation, and arthrotomy for unstable slipped capital femoral epiphysis.
abstract: BACKGROUND
  The management of unstable slipped capital femoral epiphysis (SCFE) is controversial. A high incidence of avascular necrosis (AVN) has been reported after unstable SCFE.
  
  
  METHODS
  Twenty-eight consecutive patients with thirty unstable SCFE underwent urgent reduction and fixation with two 6.5-mm cannulated screws. Positional reduction was performed in 25 cases. Arthrotomy was performed percutaneously in 16 cases and as part of an open capsulotomy in 5 cases.
  
  
  RESULTS
  Slip severity was mild in 13 patients, moderate in 9, and severe in 8. At mean duration of follow-up of 5.5 years (range: 2.0 to 11.2), 4 patients reported groin pain, and 8 patients reported a limp. Four patients developed AVN. One patient experienced slip progression and no patient developed chondrolysis.
  
  
  CONCLUSIONS
  Treatment of unstable SCFE with urgent positional reduction with accompanying arthrotomy and fixation through 2 cannulated screws resulted in a low incidence of slip progression and AVN.
  
  
  METHODS
  Therapeutic study, level 4 (case series, no or historical control group).
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, and St Louis Children's Hospital, St Louis, MO 63110, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Chen
authors.forename: Perry L
authors.initials: PL
authors.lastname: Schoenecker
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Dobbs
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Szymanski
authors.forename: J Eric
authors.initials: JE
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome