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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.