Abstract
AimTo determine current practice recommendations for the treatment of slipped capital femoral epiphysis (SCFE) among members of the European Paediatric Orthopaedic Society (EPOS).Materials and methodsA questionnaire with 4 case vignettes of a 12-year-old boy presenting with a stable and unstable SCFE. Each, stable and unstable slips, was of mild (20° epiphyseal-shaft angle) and of severe (60° epiphyseal-shaft angle) degree was sent to all members of EPOS in 2009 in order to ascertain their views on the best management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the anticipated need for secondary surgery.ResultsThe response rate was 25% (72/287). The participating surgeons’ average workload was 76% in paediatric orthopaedics, with mean 16 years of experience. Surgeons were most consistent in their advice for stable slips, where around 90% of the respondents did not recommend a reduction of the slip regardless of severity of slip. Seventy per cent of the respondents recommended the use of only one screw for fixation of a stable slip and for mild unstable slips. For severe unstable slips, 46% of surgeons recommended reduction only by positioning of the hip on the fracture table, 35% by manipulation and 11% advised open reduction. Responders were less consistent in their advice on the anticipated need for secondary osteotomies (in mild slips about 40% and about 60% in severe slips would advise an osteotomy) and on treatment of the contralateral hip (with 32% of surgeons recommending prophylactic fixation of the contralateral hip).ConclusionWithin members of EPOS, there is controversy on several aspects of the management of SCFE particularly on aspects of the treatment of unstable SCFE.SignificanceMembers of EPOS predominantly use traditional means of treatment for patients with SCFE. In contrast, the more modern treatment concepts, such as open reduction via surgical dislocation, are rarely used.
Highlights
Slipped capital femoral epiphysis (SCFE) is a rare adolescent hip disorder affecting between 0.2 and 10 per 100.000[1]
Stable and unstable slips, was of mild (20° epiphyseal-shaft angle) and of severe (60° epiphysealshaft angle) degree was sent to all members of European Paediatric Orthopaedic Society (EPOS) in 2009 in order to ascertain their views on the best management of slipped capital femoral epiphysis (SCFE)
Seventy per cent of the respondents recommended the use of only one screw for fixation of a stable slip and for mild unstable slips
Summary
Slipped capital femoral epiphysis (SCFE) is a rare adolescent hip disorder affecting between 0.2 and 10 per 100.000[1]. The current standard treatment is in situ central single-screw fixation or pinning without reduction. J Child Orthop (2011) 5:433–438 traditional treatment of SCFE did not include any reduction of the slip [3]. Older techniques of open reduction such as Dunn’s technique [4] have not gained popularity. There are controversial areas in the management of SCFE, in the treatment of unstable slips. One area of disagreement is the reduction of the slip. The concern in the unstable type is the increased risk of avascular necrosis. Reduction of the less common unstable SCFE is feasible the risk of avascular necrosis in this type is higher [5]. Recent studies show good results of open reduction [6, 7]
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