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Stable Slipped Capital Femoral Epiphysis: Evaluation and Management

Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington.

Slipped capital femoral epiphysis (SCFE) has been classified traditionally on the basis of the duration of symptoms, but it has recently been recognized that this classification system may be misleading. It has instead been recommended that slips be classified on the basis of the presence or absence of gross instability between the epiphysis and the metaphysis. An adolescent with chronic SCFE has had symptoms for more than 3 weeks and does not have physeal instability. The first priority of treatment of stable chronic SCFE is to avoid the complications of avascular necrosis and chondrolysis while securing the epiphysis from further slippage. The treatment of choice for stable chronic SCFE is stabilization in situ, which can be most easily achieved with single-screw fixation. Primary realignment procedures, such as osteotomies, are not recommended.