Treatment

The initial aim of management should be to prevent slip progression and avoid complication. Patient should be given crutches or put in a wheel chair to prevent further slipping and immediate orthopaedic referral should be arranged (1)

Treatment of SCFE is urgent (2).

• the only lasting form of treatment is surgical, where the slipped head is pinned in position (or pinned plus an osteotomy)
  • standard treatment for SCFE is with in situ fixation with a single screw
  • some recommend the use of 2 screws for unstable slips (2)
• attempts to return the head to its normal position may result in avascular necrosis of the femoral head.
• a slip of less than 50% is treated by pinning in situ, but slip of more than 50% requires osteotomy and pinning, with a much greater risk of avascular necrosis (3)

There may be a place for the prophylactic fixing of the contralateral epiphysis.

• not recommended for most patients, indicated in
  • patients at high risk of subsequent slips e.g - patients with obesity or an endocrine disorder
  • those who have a low likelihood of follow-up.

Surgery may aslo be required for discrepancies in limb length. A hip replacement may be required in early adult life because of degenerative joint disease.

Unilateral SCFE patients should be followed up closely due to the possibility of developing contralateral SCFE (2).

Reference:

• (1) Peck D. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician. 2010;82(3):258-62.
• (2) Mashru RP et al. Knee pain in a 12 year old girl. Hospital Physician 2006:42(6)
• (3) GP magazine (26/1/04), 42.