Page 103 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Introduction
Slipped capital femoral epiphysis (SCFE) has been classified traditionally into preslip, acute, acute-on-chronic and chronic phases [1]. A more recent classification, stable and unstable, relates to weight-bearing ability and is considered more prognostic [2].
The incidence of SCFE is between 0.2 and 10 per 100 000 and 10–15% of cases of SCFE are considered to be acute and/or unstable [1]. The clinical criterion for a diagnosis of an acute SCFE is symptoms for duration of fewer than 3 weeks, although, in the views of many people, the true acute SCFE will have an unstable epiphysis that may be visible on dynamic screening or at open reduction.
The literature is controversial regarding the management of an acute, unstable SCFE. The two most severe complications of an unstable SCFE are avascular necrosis (AVN) and chondrolysis and the first aim of treatment is to avoid these complications if possible.
Tokmakova [3] reviewed a group of 240 patients with SCFE. Twenty-one patients
developed AVN and all were unstable SCFE. Other factors that were correlated
with AVN were degree of slip, the number of pins used and whether there was
partial or complete reduction of the slip. 6 One of the major questions is whether repositioning of the epiphysis is advisable
or not. De Sanctis [4] and Arnold [5] contradict Tokmakova [3]. They claim that preoperative reduction with very gentle manipulation and percutaneous fixation with a single screw [4] and K-wires [5], respectively, is the best treatment for acute SCFE and reduces the risk of AVN and chondrolysis.
Recently, a questionnaire was sent to all Pediatric Orthopaedic Society of North America members to survey their ideas on management [6]. Only 33.1% (263 of 794) responded. An agreement was reached on the method of patient evaluation, but discrepancies remained in the use of classification systems and fixation methods.
We used a similar questionnaire and our goal was to compare two European countries with each other and with the POSNA survey and to audit our treatment of acute/unstable SCFE.
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