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Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

  • Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques.

Questions/purposes

We therefore addressed the following questions: (1) What is the rate of osteonecrosis of the femoral head after treatment of unstable SCFE? (2) What treatment modalities have been used for unstable SCFE and (3) what are the reported complications?

Methods

We performed a systematic electronic literature search for the keywords unstable and slipped capital femoral epiphysis and identified 199 articles. Of these, 60 met our inclusion criteria. Fifteen articles were included for analysis.

Results

The literature concerning the treatment and results of unstable SCFE is retrospective Level IV data that suggest an overall rate of osteonecrosis of 23.9%. Multiple treatment modalities were used for unstable SCFE treatment with varying, inconsistently recorded complications over the reporting period.

Conclusions

We found limited data concerning the rate of osteonecrosis and complications after treatment of unstable SCFE. Considering recent widespread interest in the modified Dunn procedure and the possibility of iatrogenic osteonecrosis, there is a need for prospective studies to identify complications and establish outcome based on standardized scores for established and emerging treatments of unstable SCFE.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 West Thirteen Mile Road, Suite 744, Royal Oak, MI, 48073, USA

    Ira Zaltz MD

  2. Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA

    Geneva Baca PhD & John C. Clohisy MD

Authors
  1. Ira Zaltz MD
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  2. Geneva Baca PhD
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  3. John C. Clohisy MD
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Correspondence to Ira Zaltz MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Zaltz, I., Baca, G. & Clohisy, J.C. Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis. Clin Orthop Relat Res 471, 2192–2198 (2013). https://doi.org/10.1007/s11999-012-2765-x

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  • DOI: https://doi.org/10.1007/s11999-012-2765-x

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