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What Is the Best Evidence for the Treatment of Slipped Capital Femoral Epiphysis?

Loder, Randall T. MD*,†; Dietz, Frederick R. MD

Journal of Pediatric Orthopaedics: September 2012 - Volume 32 - Issue - p S158–S165
doi: 10.1097/BPO.0b013e318259f2d1
EBM Supplement

Background: There are many different treatment methods for slipped capital femoral epiphysis (SCFE). It was the purpose of this study to review the results from the literature for different methods of SCFE treatment and on the basis of level of evidence determine the current best evidence treatment.

Methods: A systematic review of the literature was undertaken. Treatment results were grouped into 2 categories. The first was all methods without surgical hip dislocation, and the second was all methods in which surgical dislocation was used.

Results: For stable SCFEs without surgical dislocation, the best recommended treatment (mostly level IV) recommends in situ single screw fixation over multiple pin fixation, epiphysiodesis, osteotomy, or spica cast. For the unstable SCFEs without surgical dislocation (all level IV), the best recommended treatment is urgent reduction with decompression and internal fixation. For both stable and unstable SCFEs, the short-term small series in the literature (all level IV) does not demonstrate an advantage or improvement in outcomes compared with in situ single screw fixation for stable SCFE and urgent reduction, decompression, and internal fixation in unstable SCFEs.

Conclusions: A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation.

Level of Evidence: Level IV, systematic review of level IV studies.

*James Whitcomb Riley Children’s Hospital

Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN

Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Randall T. Loder, MD, 705 Riley Hospital Drive, ROC 4250, Indianapolis, IN 46202. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.