Urgent reduction, fixation, and arthrotomy for unstable slipped capital femoral epiphysis

BACKGROUND: The management of unstable slipped capital femoral epiphysis (SCFE) is controversial. A high incidence of avascular necrosis (AVN) has been reported after unstable SCFE. METHODS: Twenty-eight consecutive patients with thirty unstable SCFE underwent urgent reduction and fixation with two 6.5-mm cannulated screws. Positional reduction was performed in 25 cases. Arthrotomy was performed percutaneously in 16 cases and as part of an open capsulotomy in 5 cases. RESULTS: Slip severity was mild in 13 patients, moderate in 9, and severe in 8. At mean duration of follow-up of 5.5 years (range: 2.0 to 11.2), 4 patients reported groin pain, and 8 patients reported a limp. Four patients developed AVN. One patient experienced slip progression and no patient developed chondrolysis. CONCLUSIONS: Treatment of unstable SCFE with urgent positional reduction with accompanying arthrotomy and fixation through 2 cannulated screws resulted in a low incidence of slip progression and AVN. LEVEL OF EVIDENCE: Therapeutic study, level 4 (case series, no or historical control group).