We have read the article of Dr Eduardo Rached et al. titled ‘Slipped capital femoral epiphysis: reduction as a risk factor for avascular necrosis’ with great interest 1. While generally agreeing with them, we would like to share our thoughts with them and ask a few questions.
Although the authors mentioned the preoperative degree of slippage and postoperative range of avascular necrosis, they did not present either preoperative or postoperative radiographs to indicate the preoperative severity of slipped capital femoral epiphysis (SCFE), or results with respect to union and the presence of complications postoperatively.
We believe that the current study mainly suffers from the time period of data collection, because no patient was evaluated after 2004. Since open reduction by safety dislocation of the hip joint was described 2, this technique has become popular for the surgical treatment of moderate and severe displaced SCFE 2–4. In our daily practice, we can achieve satisfactory results using open reduction and anatomic fixation in patients with moderate and severe SCFE. In addition, because of protection of the femoral head blood supply, the possibility of avascular necrosis may decrease depending on the knowledge of surgical technique. We should also be prepared for the late complications of mild SCFE with cam-type femoroacetabular impingement syndromes after in-situ pinning.
We would like to know whether the authors have any comment on and experience with open reduction and fixation with safe dislocation of the hip joint in patients with severe SCFE.
Conflicts of interest
There are no conflicts of interest.
1. Rached E, Akkari M, Braga SR, Minutti MF, Santili C. Slipped capital femoral epiphysis: reduction as a risk factor for avascular necrosis. J Pediatr Orthop Part B. 2012;21:331–334
2. Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect. 2008;57:499–507
3. Massè A, Aprato A, Grappiolo G, Turchetto L, Campacci A, Ganz R. Surgical hip dislocation for anatomic reorientation of slipped capital femoral epiphysis: preliminary results. Hip Int. 2012;22:137–144
4. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol. 2007;19:389–410