Cutting-Edge Pediatric Orthopaedics 2017: A Global Perspective
If the treatment of a stable slipped capital femoral epiphysis with mild to moderate displacement with in situ pinning is well accepted around the world, controversy still exists with regard to the treatment of the severe displaced or the acute unstable hip. The high percentage of reconstructive surgery in long-term follow-ups or the high incidence of avascular necrosis, has led in the past 17 years to new investigation modalities and surgical approaches in order to try and alter the natural history.
The modified Dunn procedure through a surgical dislocation approach is gaining popularity for the treatment of the acute unstable hip but this requires a steep learning curve that may not be accessible for all pediatric orthopaedic surgeons. The method described by Klaus Parsch et al1 with similar results, but is easy to learn, should not be forgotten. For the severely deformed hip, as pointed out in the article, in situ pinning with either a concomitant or delayed reconstruction through an intertrochanteric osteotomy is still the preferred treatment for the vast majority of pediatric orthopaedic surgeons in Europe. Long-term follow-ups are needed in order to define the standards in these conditions and make it available for the general pediatric orthopaedic surgeon.
Manuel C. Neves, MD, MSc
Orthopaedic Department, Hospital CUF Descobertas, Rua Mario Botas, Lisbon, Portugal
1. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29:1–8.