title: Unstable SCFE: review of treatment modalities and prevalence of osteonecrosis.
abstract: BACKGROUND
  The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques.
  
  
  OBJECTIVE
  We therefore addressed the following questions: (1) What is the rate of osteonecrosis of the femoral head after treatment of unstable SCFE? (2) What treatment modalities have been used for unstable SCFE and (3) what are the reported complications?
  
  
  METHODS
  We performed a systematic electronic literature search for the keywords unstable and slipped capital femoral epiphysis and identified 199 articles. Of these, 60 met our inclusion criteria. Fifteen articles were included for analysis.
  
  
  RESULTS
  The literature concerning the treatment and results of unstable SCFE is retrospective Level IV data that suggest an overall rate of osteonecrosis of 23.9%. Multiple treatment modalities were used for unstable SCFE treatment with varying, inconsistently recorded complications over the reporting period.
  
  
  CONCLUSIONS
  We found limited data concerning the rate of osteonecrosis and complications after treatment of unstable SCFE. Considering recent widespread interest in the modified Dunn procedure and the possibility of iatrogenic osteonecrosis, there is a need for prospective studies to identify complications and establish outcome based on standardized scores for established and emerging treatments of unstable SCFE.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI 48073, USA. zaltzira@gmail.com
authors.forename: Ira
authors.initials: I
authors.lastname: Zaltz
authors.forename: Geneva
authors.initials: G
authors.lastname: Baca
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects; D015995:Prevalence; D012307:Risk Factors; D060048:Slipped Capital Femoral Epiphyses / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome