What is the treatment for a patient with Slipped Capital Femoral Epiphysis (SCFE) of the right hip?

Treatment of Slipped Capital Femoral Epiphysis (SCFE) of the Right Hip

The primary treatment for Slipped Capital Femoral Epiphysis (SCFE) of the right hip is in situ screw fixation to stabilize the epiphysis and prevent further slippage, especially for stable SCFE with slippage less than 35 degrees. 1, 2

Classification and Initial Assessment

• SCFE is classified as stable when the patient can walk (with or without aids) or unstable when the patient cannot walk even with crutches 2
• Radiographic evaluation should include both anteroposterior and lateral views, as the epiphyseal slip is best visualized on lateral radiographs 2
• The severity of SCFE is typically measured using the Southwick angle, with classifications:
  • Mild: <30°
  • Moderate: 30-50°
  • Severe: >50° 1

Treatment Algorithm Based on SCFE Classification

Stable SCFE

• Mild to Moderate Slippage (<35°):

  • In situ fixation with a single screw is the treatment of choice 1, 2
  • This approach provides high probability of long-term success with minimal risk of complications 2
  • Patients treated with in situ fixation for slips <35° show satisfactory functional outcomes and minimal evidence of impingement at long-term follow-up 1

• Moderate to Severe Slippage (>35°):

  • Consider more aggressive surgical options beyond in situ fixation 1
  • Modified Dunn procedure may provide better anatomic correction and fewer reoperations compared to delayed treatment approaches 3
  • In situ fixation followed by delayed reconstructive surgery (such as Imhauser osteotomy) may be necessary if significant deformity exists 3

Unstable SCFE

• Urgent hip joint aspiration followed by closed reduction and screw fixation 2
• This approach provides the best environment for satisfactory results while minimizing complications 2

Post-Operative Management

• Weight-bearing status should be determined based on fracture stability and healing progress 4
• Early physical therapy referral for rehabilitation is recommended 5
• Patients should be monitored with regular radiographic follow-up, typically at approximately 3 weeks post-surgery 4

Consideration for Contralateral Hip

• Consider prophylactic fixation of the contralateral hip in:
  • All girls younger than 10 years
  • All boys younger than 12 years
  • Consider on a case-by-case basis for girls under 12 and boys under 14 6
• Chronological age is a significant predictor for developing contralateral slip in patients presenting with unilateral SCFE 6

Potential Complications and Monitoring

• Monitor for signs of avascular necrosis (AVN) and chondrolysis, which are serious complications of SCFE and its treatment 7, 3
• Hip impingement may develop in cases with moderate to severe initial displacement, particularly when slip angle exceeds 35° 1
• Long-term follow-up is essential to monitor for development of femoroacetabular impingement and early osteoarthritis 7, 3

Rehabilitation Considerations

• Physical therapy should focus on:
  • Maintaining range of motion of unaffected joints 4
  • Strengthening exercises as healing progresses 5
  • Gait training with appropriate assistive devices if needed 5
• Validated patient-reported outcome measures should be used to monitor treatment response 5