Page 110 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 6
of two European centers shows a slightly lower rate (9%) of prophylactic pinning than was noted in the POSNA study (12%) [6].
Despite the known difficulties associated with the removal of metalwork in cases of SCFE, overall 21% of our study group admitted to always removing the implants. In contrast to the POSNA study [6], removal of metalwork was less likely with an experienced surgeon.
One of the limitations of this study is that we have only surveyed orthopaedic surgeons who are members of the Dutch or British Paediatric Orthopaedic Society. In both countries, orthopaedic surgeons who are not members of these societies do treat these children as well and their views may differ. Similarly, no questionnaire can cover all the factors that a surgeon considers when determining a management plan for a patient with an acute, unstable SCFE as was highlighted by the number of free text comments that were added to the questionnaire. The aim of this study was to audit the assessment and management of the acute/ unstable SCFE and despite the deficiencies of the study, significant, interesting information has been obtained that highlights the similarities and differences in the management of this condition between two European countries. The comparison with the POSNA [6] study also emphasizes some perhaps unexpected similarities and differences with regard to method of fixation, prophylactic fixation and removal of metalwork. Such surveys remind us that cultural influences may affect our attitudes to management perhaps by differences in the understanding and interpretation of scientific data. The design of any multicentre study hoping to identify the most effective method of management may need to take this into consideration.
Acknowledgement
We would like to thank Dr I. Sierevelt for the statistical advice and expertise in the preparation and interpretation of the data for this study.
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