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Treatment Options for Slipped Capital Femoral Epiphysis

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OrthopaedicsOne Poll: What is your preferred treatment for an unstable slipped capital femoral epiphysis?

Since early 2000, elective surgical dislocation of the hip joint, as described by Reinhold Ganz, has permitted us to gain a better understanding of intra-articular hip disease, as well as provide a safe and effective reproducible technique in treating the young adult with hip disease. This technique, now practiced worldwide by specialized hip surgeons, has been applied to a variety of pathology and within different stages of the arthritic process for both joint preservation and replacement (ie, resurfacing). Consequently, the risk and complications of this approach have been well documented, with trochanteric non-union being 1% or less and removal of painful internal fixation being the most commonly reported at about 30%.

The clinical outcome of this technique in the skeletally mature patient has been reproducible with no reported cases of osteonecrosis or neck fracture. Consequently, it would only be natural to apply this technique in the treatment of the skeletally immature patients with unstable subcapital femoral epiphysis where the gains of optimizing functional anatomy are critical to minimize the risks of developing significant intra-articular hip damage.

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The merits of open reduction and internal fixation using surgical dislocation of the hip joint, which was originally described by Dunn and modified by Ganz, versus a less-invasive technique of in-situ pinning +/- gentle reduction provides an interesting debate from two centers with a long tradition in the treatment of the pediatric hip. It is only through these exchanges that we can refine the indications of evolving surgical techniques and how to best optimize their outcomes.

Viewpoint 1: Simon P. Kelley, MBChB, FRCS (Tr and Orth); M. Lucas Murnaghan, MD, MEd, FRCSC

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Slipped Capital Femoral Epiphysis - In-Situ Screw Fixation

Viewpoint 2: Young-Jo Kim, MD, PhD

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Case for Open Reduction and Fixation of Acute SCFE

 

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Viewpoint:Poll - Treatment Options for Slipped Capital Femoral Epiphysis