Current Practice in the Management of Slipped Capital Femoral Epiphysis.

BACKGROUND: The most widely used treatment for slipped capital femoral epiphysis (SCFE) is in situ fixation. In an attempt to reduce the chances of impingement, osteoarthritis, and osteonecrosis, surgeons have started adopting newer surgical techniques. The purpose of this study was to determine the current pattern of treating SCFE.
METHODS: A questionnaire was sent electronically to all of the members of the Pediatric Orthopaedic Society of North America. The data were analyzed dividing surgeons into academic versus private practice, years of practice, and number of SCFEs treated per year.
RESULTS: Of 990 members, 277 (28%) responded to the survey.Type of practice (academic, n=181 vs. private, n=51): For unstable severe SCFE, surgeons in academic practice use the surgical hip dislocation (SHD) approach significantly more frequently (35.7% vs. 14.9%; P=0.02). A radiolucent table is used significantly more frequently in academic practice for both stable (50.6% vs. 29.8%; P=0.01) and unstable (39.6% vs. 15.2%; P=0.002) SCFE. Fully threaded cannulated screws (44.4% vs. 27.1%; P=0.03), open capsular decompression (63.9% vs. 32.4%; P=0.001), contralateral pinning (79% vs. 58.7%; P=0.005), and postoperative magnetic resonance imaging (MRI) (15.5% vs. 3.9%; P=0.03) are significantly more frequent in academic practice.Years of practice (≤15 y, n=124 vs. >15 y, n=140): For severe stable SCFE, surgeons practicing for ≤15 years do acute osteotomies significantly less frequently (1.8% vs. 9%; P=0.004) and perform SHD significantly more frequently (20.2% vs. 8.2%; P=0.004). For unstable moderate SCFE, SHD is utilized significantly more frequently by surgeons ≤15 years in practice (29.8% vs. 16.5%; P=0.04). Bilateral frog-leg lateral views (86.4% vs. 73.7%; P=0.04), preoperative MRI (36.1% vs. 20.6%; P=0.006), open capsular decompression (69.3% vs. 51.7%; P=0.01) are significantly more frequent among surgeons ≤15 years in practice.Number of SCFE treated per year (<10, n=129 vs. ≥10, n=136): For unstable severe SCFE, surgeons treating ≥10/y perform SHD significantly more frequently (38.6% vs. 26.1%; P=0.02) and do in situ fixation with manual reduction significantly less frequently (11.8% vs. 21.8%; P=0.02). Radiolucent table (54.3% vs. 38%; P=0.01), 7.5 mm screw versus 6.5 mm (62% vs. 45.4%; P=0.01), contralateral pinning (78.9% vs. 67.8%; P=0.04), postoperative MRI (17.6% vs. 9.3%; P=0.04), and postoperative computed tomography (14.7% vs. 7%; 0.04) are significantly more frequent among surgeons doing ≥10/y. Elective implant removal is more common among surgeons treating <10/y (16.2% vs. 6.9%; P=0.02).
CONCLUSIONS: Treatment of SCFE varies significantly depending on the surgeon's type of practice, years in practice, and numbers treated per year. Surgeons in academic practice, surgeons with ≤15 years in practice, and surgeons treating greater number of SCFEs are more likely to use SHD to acutely reduce the slip.