Abstract
An unstable slipped capital femoral epiphysis (SCFE) is characterized by the inability to walk and is associated with a high risk of osteonecrosis. An unstable SCFE is less common than a stable SCFE; however, the demographics are similar in both groups of patients with SCFE. The diagnosis of an unstable SCFE is characterized by a history of antecedent pain and the inability to walk on examination, and it is confirmed by radiographic assessment. Management of an unstable SCFE includes closed reduction, open reduction, and capital realignment, which have all been noted to have lower rates of osteonecrosis than reported in historic reports. All management approaches have certain advantages and disadvantages, and comparative studies are needed to guide clinical decision-making.
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