Surgical Technique: In Situ Pinning of Unstable Slipped Capital Femoral Epiphysis

Abstract

3An unstable slipped capital femoral epiphysis (SCFE) typically presents with fracture-like hip and/or knee pain, limp, and inability to bear weight for days or weeks. Some report an inciting event but many patients do not report a major traumatic event. The diagnosis is confirmed with an anterior posterior (AP) and cross-table lateral radiograph of the affected hip. The workup should also include a cross-table or frog leg lateral radiograph of the contralateral hip to screen for a contralateral SCFE if not obvious on the AP radiograph. In situ pinning remains the mainstay of treatment for these conditions due to relative simplicity of procedure and historically positive outcomes. Recently, unstable SCFEs have been associated with a high rate of avascular necrosis (AVN) and slip progression with in situ pinning, which has led to other techniques that will be discussed in other chapters. In this chapter, we will discuss our technique for in situ pinning of an unstable SCFE. Double vs. single-screw fixation has been heavily debated within the literature. The mechanical superiority of double-screw fixation must be weighed against the increased risk of chondrolysis and AVN. The author’s preferred technique is to accept the reduction obtained from positioning the patient on the fracture table and perform single-screw fixation across the femoral physis with a 7.3 mm partially threaded cannulated screw.