Page 108 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 6
family regarding the development of new symptoms from the normal hip. Among surgeons in the UK, 6% always offered prophylactic pinning of the normal side and 9% never did. These results were significantly different from those in the Dutch group in which 15% always and 36% never pinned the normal hip (P<0.05). Eighty-two per cent of surgeons with less than 15 years of experience will pin prophylactically in certain circumstances compared with 53% of the group with more than 15 years experience (P<0.001).
Overall, 21% of respondents always remove the metal work after fusion of the physis, but 43% felt that the decision to remove the metal would depend on factors such as a complaint of pain, unsatisfactory screw position, the possibility of a second operation or signs of AVN. Again, significant differences were found between the Dutch and the British: the British surgeons were less likely to remove metalwork than their Dutch colleagues (P < 0.05). In both countries, however, the more experienced surgeons were less likely to remove the metalwork. Surgeons who advised removal of metalwork tended to leave the screws protruding from the lateral femoral cortex to aid the removal process.
Discussion
The treatment of an acute, unstable SCFE remains controversial. In this study, there was general agreement on the method of evaluation of such a case both within each country and between the two countries and this also agreed with the results of the POSNA study [6].
As in North America, plain radiographs are used universally for the assessment of an acute unstable SCFE but a surprising number of surgeons (30%) used other imaging techniques as well.
The use of a traction table for patient positioning is very common in the UK and more so than in North America [6], while more than 50% of the Dutch were happier to have the patient lying free on a radiolucent table. Blasier [10] showed that operating time was prolonged significantly when a fracture table was used but with no significant difference in screw position in a group of stable SCFE. This could be different for the unstable slip. The future might involve computer- assisted cannulated screw fixation, although at the moment this is associated with high additional costs [3].
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