Slipped Capital Femoral Epiphysis: The European Perspective.

Treatment of slipped capital femoral epiphysis remains a contentious and debated issue. The opinion for the correct method of treatment can differ not only between different continents and nations, but also between units and surgeons within individual units. We aim to review the European perspective on the treatment of slipped capital femoral epiphysis and consider the trends for treatment among the European orthopaedic surgical community.

Opinion survey of members of British Society of Children's Orthopaedic Surgery related to specific case scenarios in slipped capital femoral epiphysis.

The aim of this study was to assess contemporary management of slipped capital femoral epiphysis (SCFE) by surveying members of the British Society of Children's Orthopaedic Surgery (BSCOS). A questionnaire with five case vignettes was used. Two questions examined the timing of surgery for an acute unstable SCFE in a child presenting at 6 and 48 h after start of symptoms. Two further questions explored the preferred method of fixation in mild and severe stable SCFE. The final question examined the management of the contralateral normal hip. Responses were entered into an Excel spreadsheet and the data was analysed using a χ-test. The response rate was 56% (110/196). Overall, 88% (97/110) responded that if a child presented with an acute unstable SCFE within 6 h, they would treat it within 24 h of presentation, compared with 41% (45/110) for one presenting 48 h after the onset of symptoms (P<0.0001). Overall, 53% (58/110) of surveyed BSCOS members would offer surgery for an unstable SCFE between 1 and 7 days after onset of symptoms. Single screw fixation in situ for mild stable SCFE was advocated by 96% (106/110) with 71% (78/110) using this method for the treatment of severe stable SCFE. Corrective osteotomy is used by 2% (2/110) and 25% (28/110) of respondents for mild and severe stable SCFE, respectively (P<0.0001). Surgeons preferring osteotomy are more likely to perform an intracapsular technique. Prophylactic fixation of the contralateral normal hip was performed by 27% (30/110) of respondents. There are significant differences in opinions between BSCOS members as to the optimal management of SCFE. This reflects the variable recommendations and quality in the current scientific literature. Further research is therefore required to determine best practice and enable consensus to be reached.

Effects of the grade, stability, chronological classification and being either unilateral or bilateral of the slip on the treatment by in situ single screw fixation of patients with slipped capital femoral epiphysis.

PURPOSE: The effects of the grade, stability, chronological classification and being either unilateral or bilateral of the slip on the outcomes of the treatment by in situ single screw fixation of the Slipped capital femoral epiphysis were investigated. METHODS: 34 hips of 24 patients (7 girls, 17 boys; mean age 12.04 years; range 9-14; 14 slips acute, 7 slips acute on chronic, 13 slips chronic; 22 slips stable, 12 slips unstable; 20 slips Grade 1, 13 slips Grade 2, 1 slips Grade 3) between 2003 and 2009 were involved in the study. During the controls; range of motion, walking abnormalities, Trendelenburg test, use of assistive devices during mobilization, existence of pain and complications were evaluated. The evaluation of clinical results was made according to the average Harris Hip Score. RESULTS: 10 of 24 patients showed evidence of a slip of the contralateral hip on average 10.6 (6-16) months after the initial operation. At mean 41.52 ± 8.08 months controls, the Harris Hip Score was found 77.41 ± 14.66, hip-joint motions, flexion 120° (70°-140°), abduction 40° (20°-60°), internal rotation 25° (10°-40°). Evaluation at the last follow-up showed significant differences between single hip slip than both hip slip, stable slip than unstable slip and Grade 1 slip than Grade 2 slip. In the last control of one patient with a Grade 3 slip, avascular necrosis has been observed. Considering the effect on the clinical results of the chronological classification of the no slip, significant differences have been seen between the clinical outcomes of the acute, chronic or acute on chronic slips. DISCUSSION: The outcomes of the treatment by in situ single screw fixation are negatively affected by increase in the grade of slip, instability of the slip and existence of slip at both hips.

Surgical management of healed slipped capital femoral epiphysis.

Slipped capital femoral epiphysis (SCFE) results in posterior and inferior displacement of the epiphysis on the femoral neck. In most centers, the recommended initial management of stable SCFE is in situ pinning. Minimal reduction with in situ pinning is recommended for unstable SCFE. This approach does not restore the normal anatomy of the hip joint, and the resulting proximal femoral deformity may cause femoroacetabular impingement. Patients with femoroacetabular impingement experience reduced hip range of motion as well as hip pain, and they are at risk of early-onset hip osteoarthritis. Techniques for managing this deformity include arthroscopic femoral neck osteochondroplasty, a limited anterior hip approach or surgical hip dislocation, and flexion intertrochanteric osteotomy. These surgical techniques should be considered for patients with healed SCFE deformity who present with hip pain at an early age.