Unstable slipped capital femoral epiphysis

Slipped capital femoral epiphysis is one of the most common major disorder of the hip in adolescence. Most of the slips are stable and chronic, however about 10% are unstable with sudden onset of pain severe enough to prevent weight bearing. We analyzed cases of unstable slipped capital femoral epiphysis operated upon at our orthopaedic department from 2000 to 2007. During this seven-year period 50 patients (53 hips) underwent surgery for slipped capital femoral epiphysis. Eight patients (8 hips, 15%) were unstable, six boys and two girls, age 8 to 14 (mean 12 years 3 months). Six patients could not bear weight at all and two suffered strong pain when walking. Six patients had a severe grade III slip according to Müller and two were grade II. After a short period of preoperative cutaneous traction, gentle manual closed reduction and fixation with canulated screws and Kirschner wires was performed in all patients. Full range of hip motion was achieved in all patients after a course of physical therapy. No avascular necrosis or chondrolysis were noted in our series. Our treatment protocol for unstable slipped capital femoral epiphysis is emergency admission, gentle closed manual reduction and fixation using appropriate osteosynthetic material.

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