The Hip: Preservation, Replacement and Revision

Acute Slip

- Discussion:
    - 11% of cases
    - occurs following significant trauma, produces sudden onset of pain severe enough to prevent weight bearing;
    - pts usually report minimal or no previous symtoms;

- Treatment:
    - reduction vs. traction:
          - gentle repositioning can reduce the deformity of an acute slip.
          - gradual traction may be safer than acute manipulative reduction;
          - full reduction may lead to avascular necrosis of femoral head;
          - manipulation should not be attempted for an acute slip that has been present for more than 2 weeks.
    - pin placement:
         - in acute slips, two or three threaded pins are inserted across epiphysis to prevent further slippage;

- Complications:
     - avascular necrosis:
          - risk factors:
               - severity of slip
               - reduction of slip
               - location of pins (questionable significance);
                    - need to avoid anterolateral cortex;
               - number of pins (questionable significance);
          - risk of AVN is approx 20-50% w/ attempted reduction vs. less than 5% w/o reduction;

- case example:
     - 12 yo female w/ acute slip who achieved significant reduction w/ gentle traction on fracture table

          Age 12 (preop)                                       Early postop films                 Age 14 (no AVN)

Acute slipped capital  femoral epiphysis: the importance of physeal stability.

Reduction of acutely slipped upper  femoral epiphysis.  

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 10:24 am