Page 27 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Primary Treatment.
Conservative Treatment.
Although conservative treatment with a plaster cast has been described [105],
most surgeons would choose for an operative treatment. Santini described 18
patients with 26 SCFE hips who were referred to him with non-surgical treatment. 2 Retrospectively, 73 % of these hips showed progression of the slip over time,
concluding that a conservative treatment is an poor option for this severe disorder
[121].
Single screw fixation
The favoured surgical procedure is one percutaneous single screw fixation with intraoperative fluoroscopy in SCFE [9, 73, 88, 131, 134, 142]. The literature highlights this as the preferred method for stable and unstable mild slips [1]. Single screw fixation was compared to bonepeg epiphysiodesis, based on 38 year follow up, with the screw fixation being chosen as the best option, given that this technique is less demanding and because postoperatively no traction is needed [147]. There appears to be no consensus regarding the best treatments of moderate and severe slips. In the latter slips remodelling potential of the deformity of the slipped femoral head may be insufficient to create a congruent joint and leaves a joint with reduced mobility and may cause femoral acetabular impingement, which will be discussed later.
Unstable SCFE treatment.
There seems to be no consensus between countries or continents about how to treat unstable/acute SCFE. There are different approaches in diagnosis and treatment between the UK and the Netherlands which also differ from those of the Pediatric Orthopaedic Surgeons North America (POSNA) [87, 150]. Overall, the UK and the Netherlands diagnosed patients similarly and agreed with the need for urgent management. Sixty-six per cent did not reposition the slip. Significant differences were observed in attitude towards single screw usage, prophylactic pinning and screw removal both between the two European countries and compared to North America. The discussion to reduce the slip and the timing of this reduction, if done, is ongoing in the literature. The principal risk in this treatment is avascular necrosis of the femoral head. Sonnega et al. [131] used an EPOS questionnaire study and found that the majority of surgeons use reduction by only gentle positioning of the hip in the fracture table and a percutaneous screw fixation.
Slipped Capital Femoral Epiphysis
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