title: Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study.
abstract: OBJECTIVE
  The treatment of unstable slipped capital femoral epiphysis (SCFE) remains controversial. Surgical dislocation and open reduction has the potential to significantly reduce the rate of avascular necrosis (AVN) by allowing direct preservation of the femoral head blood supply. The purpose of this study was to determine if open reduction of the unstable SCFE by means of surgical hip dislocation reduced the risk of AVN compared with closed reduction and percutaneous pinning.
  
  
  METHODS
  We reviewed the medical records and radiographs of patients treated at our institution between the years 2000 and 2008. Sex, age, side of slip, precipitating event, pre- and post-operative anterior physeal separation (APS) and slip angle, slip severity, time between inciting event and surgical treatment, number of screws used, development of AVN, and need for subsequent surgery were evaluated. Statistical analysis was performed to compare risk factors and occurrence of AVN.
  
  
  RESULTS
  From 2004 to 2008, we treated 12 patients with unstable SCFEs: six had closed reduction and percutaneous pinning and six underwent open reduction by means of surgical hip dislocation. There were no statistically significant differences between the two groups regarding sex, age, slip angle, APS, time to surgery, and AVN rate. At follow-up, 4 (66.7 %) patients had AVN in the group which had open reduction, while 2 (33.3 %) patients had AVN in the group which underwent closed reduction. (p = 0.57).
  
  
  CONCLUSIONS
  Open reduction of the unstable SCFE by means of surgical dislocation of the hip does not decrease the rate of AVN when compared to closed reduction.
authors.affiliation: Division of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G-1X8 Canada.
authors.forename: Cristina
authors.initials: C
authors.lastname: Alves
authors.forename: Marie
authors.initials: M
authors.lastname: Steele
authors.forename: Unni
authors.initials: U
authors.lastname: Narayanan
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alman
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
keywords: Avascular necrosis; Closed reduction; Open reduction; Percutaneous pinning; Slipped capital femoral epiphysis; Surgical dislocation of the hip
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