Slipped capital femoral epiphysis: an update on the current management and outcomes

There has been rapid evolution in the knowledge and treatment of slipped capital femoral epiphysis (SCFE). Recent literature has added insight into a potential pathogenic mechanism of SCFE development, identified risk factors for developing a contralateral SCFE, and better defined the natural history of SCFE treated with in situ fixation. Additionally, the introduction of open surgical techniques has made possible the ability to restore anatomy while maintaining the principles of SCFE surgery: achieve stabilization, avoid avascular necrosis, and maintain function. Yet, despite the advances in open surgery and deformity correction, questions remain about widespread application of the techniques given the relative complexity involved and the unknown effect on altering the natural history of SCFE hips. Therefore, the standard of care for a stable SCFE remains in situ screw fixation with a single fully-threaded screw. For an unstable SCFE, it is recommended that an urgent, gentle reduction be performed, followed by capsular decompression, and screw fixation. Further research will help determine the effect that open surgical techniques have on unstable SCFE and avascular necrosis, stable SCFE and correcting deformity, and ultimately if the development of osteoarthritis is prevented or delayed by these techniques.