Page 107 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Treatment
Eighty-eight per cent of respondents treated the acute/unstable SCFE within 24 h of presentation. Some applied skin traction on admission and before surgery. Overall, a traction table was used by 69% of surgeons but there was a significant difference between the two countries, with 78% of British surgeons using the table compared with 46% of the Dutch (P < 0.05).
Sixty-six per cent of surgeons did not reposition the slip. If repositioning was performed, it was done gently or it occurred as an ‘accidental’ repositioning as the patient was placed on the traction table for an ‘in-situ’ fixation. Overall, 23% would aspirate the joint as part of the perioperative assessment. This approach was more than twice as common in the UK as it was in the Netherlands. Haemarthrosis suggested that there was an acute slip present and in such instances a gentle reposition was performed. A formal decompression of the joint was only performed by 29% of surgeons – the remaining 71% never decompressed the joint.
Many surgeons highlighted the fact that a reduction of the acute, unstable SCFE
should only be considered within the first 24 h of presentation. Patients presenting
later would need to wait before an ‘urgent’ elective procedure such as a cuneiform
osteotomy [8,9] could be performed. The recommended delay varied from 5 days
to 3 weeks. 6 Percutaneous screw fixation was performed by 88% of the group with many
surgeons commenting that this method was only used within 24 h of the acute event rather than within 24 h of presentation to the hospital. Treatment also varied with years of experience. Percutaneous fixation was more common (93%) in those surgeons with less than 15 years of experience. Those with more than 15 years experience opted for an open reduction and internal fixation in 21% of cases. This difference in attitude to management with increasing experience was statistically significant (P < 0.05).
A single screw was the most common fixation method (79%). In the group with > 15 years experience, 30% opted for two screws versus 14% in the group with < 15 years experience (P < 0.05). Some of the more senior surgeons felt that rotational stability was enhanced by the use of two screws.
Seventy-four per cent of surgeons admitted that the decision of whether or not to offer prophylactic pinning of the contralateral normal side depended on a variety of different factors that could vary from patient to patient. The factors quoted included co-morbidities such as obesity, endocrinological disorders, syndromes such as trisomy 21, and perhaps most importantly, the under-standing of the
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