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38 patients, and 45 hips has undergone treatment for slipped capital femoral epiphysis between 1995 and 2000. On the basis of the measurement of the head shaft angle on X-ray examination done preoperatively, hips were classified to one of the three groups--mild, moderate, and severe slippage. All patients had undergone pinning in situ as a primary treatment. All were checked out periodically, clinically and radiologically. On the last X-ray before physeal plate closure the head shaft angle was evaluated again. Retrospectively the head neck angle was measured as well. After the average 2.5 years long observation there was stated, that according to Southwick clinical and radiological classification 73% of good and very good outcomes were among moderate and severe slippages. On X-ray assessment 38% of initial and final projection were estimated to be comparable. Amount was inversely proportional to escalation of the slippage. On the comparable projections remodeling of the proximal femur occurred in 27% of the head-shaft angle cases, and 39% on the head-neck angle cases. Remodeling often concerned younger patients and greater slippages. Primary in situ stabilization in treatment SCFE is a correct therapy. Because of spontaneous remodeling occurring in a large amount of hips after stabilization making, a decision of realignment procedures should be rescheduled until remodeling is over after physeal plate closure. Conventional X-rays examination is a method of qualitative, not quantitative monitoring of a treatment of SCFE.

We reviewed 61 hips in 50 children (33 boys and 17 girls) with slipped capital femoral epiphysis (SCFE), all treated by in situ pinning. Average age of our patients was 11.8 years (range, from 8 to 15 years). The average clinical and radiographic follow-up was 7.4 years. By studying the changes in physeal-shalt angle on radiographs in Lauenstein (frog) position, we found evidence of physeal remodeling in three (8%) of 38 mild and seven (30%) of 23 moderate slips. Remodeling of the proximal femoral metaphysis occurred in 92% of hips with a head-shaft angle less than 30 degrees and in 52% of hips between 30 degrees and 60 degrees. A process of local resorption and apposition of bone seems to be essential to final remodeling. The probability of remodeling was significantly less the greater the degree of slip, but was significantly increased among children 11 years old or younger and if the triradiate cartilage was open at the time of presentation. The range of internal rotation was significantly greater in those hips that remodeled. Pinning in situ of a slipped capital femoral epiphysis represents a simple, quick and effective method of treatment, allowing remodeling in mild and moderate slips.

Acute slipped capital femoral epiphysis is a rare adolescent hip disorder, which may be a problem for orthopedic surgeon. No series to date has demonstrated the superiority of any treatment method. The purpose of the study was to evaluate the outcome of treatment and to assess the risk factors of avascular necrosis associated with this condition. Fourteen cases of acute slipped capital femoral epiphysis were treated with closed reduction and pinning. There were 9 boys and 5 girls. The average age at presentation was 11.8 years (range 9.1-15.3). Eight children were treated 4-10 days and six within 48 hours of the onset of their acute symptoms. The severity of the slip was classified according to the system of Southwick. Presence of chondrolysis and avascular necrosis was estimated. The clinical results were graded with the use of the criteria of Aadelen et al. Four slips were classified as mild, seven as moderate and three as severe. Average follow up was 5.2 years (range from 2.4 to 14.3). In two hips with severe slip AVN developed. One of these cases was treated within 48 hours and one after 7 days. Chondrolysis developed in one hip and was associated with presence of intra-articular fixation. Twelve of the fourteen hips had good and vary good results and remaining 2 with AVN had poor. Closed reduction and pinning in acute slipped capital femoral epiphysis is an effective and giving satisfactory outcome method of treatment. Early reduction is not associated with a high rate of AVN and should be performed as soon as possible. More severe slips were noted to have an increased risk of AVN.