Ortho Oracle - orthopaedic operative atlas
Home » Joints » Hip » Treatment: SCFE:

Treatment: SCFE:

- Discussion:
     - acute slip:
     - acute on chronic slip:
     - chronic slip:
     - treatment of is designed to fuse epiphysis on femoral neck which prevents further slipping;
     - this usually involves insertion of one or more screws into anterior aspect of  greater trochanter or femoral neck (depending on degree of
             slip) to enter center of epiphysis;
             - this is achieved w/ care to avoid penetration into the hip joint which can lead to chondrolysis and care to avoid manipulation 
                    (in chronic or acute on chronic cases) which may cause osteonecrosis;
     - rule out bilateral SCFE:
             - before proceding on with screw fixation of the "injured side," be sure that the "uninjured side" does not have a subacute slip (w/ a
                    frog leg lateral as well as an AP of the pelvis);

- Surgical Considerations:
    - timing:
    - reduction vs in situ pinning
    - screw placement and number of screws:  
    - pinning of the contralateral hip:

- Remodeling:
    - whether or not remodeling occurs following treatment of SCFE, ROM and gait improve, allowing most patients to have acceptable function;
    - rather than actual remodeling, some believe that there is resorption of bone on anterolateral aspect of neck of femur, resolution of muscle spasm &
    - references:
           - Physeal remodeling after internal fixation of slipped capital femoral epiphyses.
           - Remodeling of the femoral neck after in situ pinning for slipped capital femoral epiphysis.
           - Clinical outcome and assessment of spontaneous remodeling of slipping angle in SCFE.
           - Remodeling after in situ pinning for slipped capital femoral epiphysis.

- References for SCFE:

Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership.

Intra-operative arthrography facilitates accurate screw fixation of a slipped capital femoral epiphysis.

Slipped capital femoral epiphysis in skeletally immature patients.

Pinning in slipped capital femoral epiphysis: long-term follow-up study.

Valgus slipped capital femoral epiphysis.

Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.