Treatment for unstable slipped capital femoral epiphysis: Current status and future challenge in Japan.
BACKGROUND
Treatment for unstable slipped capital femoral epiphysis (SCFE) is challenging and controversial. For many years, the debate centered around closed treatments and especially the pros and cons of manual reduction and its concrete procedure. However, recent studies reported on open treatments such as open reduction through an anterior approach and modified Dunn procedure. Being in a period of such transition, we investigated the current status and future challenge of treatment for unstable SCFE.


METHODS
A questionnaire survey of medical institutions specializing in pediatric hip disorders across Japan was conducted. Survey items were the accurate diagnosis of physeal stability, the pre- and intra-operative evaluation of epiphyseal hemodynamics, and current treatment strategy.


RESULTS
Survey responses returned from 29 out of 40 participant institutions (response rate: 73%) revealed that 55% of the institutions evaluated physeal stability based on clinical findings of ambulation capability in accordance with the Loder classification. Another 38% diagnosed physeal stability comprehensively by combining the Loder classification and imaging findings. Epiphyseal hemodynamics was assessed preoperatively in 18% of the institutions, effectively using angiography, contrast-enhanced magnetic resonance imaging (MRI), and bone scintigraphy. Intraoperative assessment was performed in 13% based on the bleeding through a drilling hole on the articular surface and observation of the cancellous bone color during open surgeries. As a treatment strategy, 52% of the institutions used in-situ fixation, while another 38% used manual reduction and internal fixation. On the other hand, open reduction was used at 3 institutions (the remaining 10%): the modified Dunn procedure at 2 institutions and arthrotomy at 1 institution.


CONCLUSIONS
Treatment for unstable SCFE remains controversial, but closed treatments without hemodynamic monitoring is no longer the center of the controversy. Today, the topic of the discussion is shifting toward how to correlate hemodynamic findings with treatment procedures and the indications for open treatments.
Department of Orthopaedic Surgery, The Jikei University Daisan Hospital, Japan. Electronic address: t-otani@jikei.ac.jp.
Takuya
T
Otani
Department of Orthopaedic Surgery, Shiga Medical Center for Children, Japan.
Tohru
T
Futami
Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, Japan.
Atsushi
A
Kita
Department of Pediatric Orthopaedic Surgery, Osaka City General Hospital, Japan.
Toshio
T
Kitano
Division of Orthopaedic Surgery, Chiba Children's Hospital, Japan.
Takashi
T
Saisu
Department of Orthopaedic Surgery, Kobe Children's Hospital, Japan.
Shinichi
S
Satsuma
Department of Orthopaedic Surgery, The Jikei University Daisan Hospital, Japan.
Yasuhiko
Y
Kawaguchi
D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D000072700:Conservative Treatment / Q000592:standards* / Q000639:trends; D005260:Female; D005544:Forecasting; D006801:Humans; D007564:Japan; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D019637:Orthopedic Procedures / Q000592:standards* / Q000639:trends; D060048:Slipped Capital Femoral Epiphyses / Q000000981:diagnostic imaging* / Q000628:therapy*; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D016896:Treatment Outcome