Urgent reduction, fixation, and arthrotomy for unstable slipped capital femoral epiphysis.
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).
Chen
Ryan C
RC
Department of Orthopaedic Surgery, Washington University School of Medicine, and St Louis Children's Hospital, St Louis, MO 63110, USA.
Schoenecker
Perry L
PL
Dobbs
Matthew B
MB
Luhmann
Scott J
SJ
Szymanski
Deborah A
DA
Gordon
J Eric
JE
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