Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis

Abstract

Patients with acute or acute-on-chronic SCFE can be safely managed with straight-leg traction for up to 6 days, followed by in situ screw fixation without manipulation. Manipulation is not recommended in such slips, due to a higher avascular necrosis risk.

Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

“…Overall, 23.9% of patients developed osteonecrosis but the reported ranges varied from 0% to 58% (Table 2). Only two articles established diagnostic radiographic criteria for osteonecrosis [18,22], and only three studies documented the timeframe for establishing the diagnosis of osteonecrosis [13,16,18]. For 13 studies, the minimum length of followup was 12 months (average, 36 months; range, 12-72 months).…”

“…Eight studies did not report complications. Two studies reported clinical outcomes data using unvalidated measures [8,13] and one study reported radiographic outcomes for patients who developed osteonecrosis using Stulberg's classification for healed Legg-Calve-Perthes [18].…”

“…associated with the highest prevalence of osteonecrosis, considered the most serious complication after SCFE [2,3,11,13]. In 1993, Loder et al [14] proposed classifying patients based on epiphyseal stability, an approach that more accurately predicts the development of osteonecrosis.…”

Is the femoral head dead or alive before surgery of slipped capital femoral epiphysis? Interest of perfusion Magnetic Resonance Imaging

“…32e34 In-situ fixation is considered as the most safe surgical technique regarding vascularization 30,32 but its functional result could be worse because of partial reduction of upper femoral deformity. Preoperative traction is not risky 8,35,36 or has no real benefit. 5 Numerous pins or screws and upper extern quadrant localization of pins or screws are also considered as risk factors.…”

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

“…A number of treatments options were reported for the study population including epiphysiodesis [10,11], pinning in situ (PIS) [1,7,[12][13][14][15][16][17][18][19], closed reduction and pinning (CRIF) [4,5,11,15,16,18,[20][21][22][23][24][25], open reduction and physeal osteotomy (PO) [1,7,15,26] open reduction and internal fixation (ORIF) [23][24][25]27] and surgical dislocation (SD) [13,15,[28][29][30].…”