Results of treating slipped capital femoral epiphysis by pinning in situ

The primary aim in treatment of chronic SUE consists of immediate stabilization of the epiphysis to prevent further slipping. For mild degrees of slipping (<30degrees), pinning in situ is the treatment of choice. With slips between 30 and 50degrees, the decision should be based on individual factors (age,functional limitation of the hip joint) whether pinning in situ is sufficient or whether an additional intertrochanteric osteotomy according to Imhauser should be performed. The choice of implant should ensure a safe and stable connection between the epiphysis and the femoral neck without resulting in a substantial impairment of growth of the femoral neck due to premature closure of the growth plate. Since 1982 we have used K wires for in situ pinning of the affected hip as well as for prophylactic pinning of the nonaffected hip with a low complication rate. In a clinical and radiological study, 65 patients with a chronic slip of less than 50degrees could be assessed after in situ pinning. Almost 75% were pain-free after a follow-up interval of 9.8 years, and 92% achieved a good or very good result according to the criteria of the Iowa hip score, the mean score being 95.1 points. According to the radiological score of Schulitz five patients (7.7%) demonstrated a grade I osteoarthritis. One patient showed a partial necrosis of the femoral head; chondrolysis was not observed.