[Management and treatment results for acute slipped capital femoral epiphysis]. / Therapieregime und Ergebnisse bei der Epiphyseolysis capitis femoris juvenilis acuta.

The priorities in treating an acute slip are to avoid avascular necrosis and chondrolysis. Other aims in the unstable situation are to prevent further slip and to correct deformity. We reviewed the management of 16 unstable slips after nearly 9 years. Fifteen patients underwent reduction and stabilization with K wires within 24 h of the onset of severe symptoms. Only one patient in this group developed avascular necrosis (6.6%) and in no case was chondrolysis seen. No correlation was noted between slip magnitude and the development of avascular necrosis. Therefore, we recommend in cases of unstable slips early reduction and stabilization to reduce the risk of avascular necrosis and chondrolysis.

[Significance and results of subcapital osteotomy in severe slipped capital femoral epiphysis]. / Stellenwert und Ergebnisse der subkapitalen Osteotomie bei der Epiphyseolysis capitis femoris lenta mit hochgradigem Abrutsch der Epiphyse.

Today treatment with in situ fixation for mild slips in chronic SCFE is undisputed. However, it is far more difficult to give a definite recommendation in cases where a severe dorsal slip of >70 degrees has already occurred. With this position of the femoral head, a severe functional deficit combined with an early onset of osteoarthritis has to be expected. With these severe slips we prefer the subcapital osteotomy, a technique which results in an almost normal anatomical alignment of femoral head and acetabulum. In the literature, this procedure is subject to controversy because of the relatively high incidence of avascular necrosis and chondrolysis. In our own small collective of five patients, we did not observe these complications in the postoperative follow-up and the clinical results were excellent. After 8.5 years the Iowa score was a mean of 91.8 points. Only one patient showed radiological signs of grade I osteoarthritis; the follow-up interval was, however, relatively short.

[Femoral head epiphyseolysis]. / Epiphyseolysis capitis femoris.

Slipped capital femoral epiphysis could be regarded as exceeding of a physiological process in puberty in which overweight of the patients seems to be the essential factor. Early clinical and radiological diagnosis are important to perform simple surgical procedures stopping further lysis and avoiding later osteoarthritis. Fixation of the femoral epiphysis with K.-wires are emphasized worldwide because of the lower complication rate. In case of severe slip osteotomies for realignment are more problematic. Long term follow-up studies have shown poor results mostly because of chondrolysis and femoral head necrosis in a high percentage. The demand on renunciation of realignment procedures in s.c.f.e. however, can't be supported. In our own patients, recently followed up, realignment osteotomies were without greater problems with no complications like chondrolysis or head necrosis. Stabile fixation of osteotomies allowed early mobilisation just after operation and may be one reason that chondrolysis didn't exist in our patient group. Considering our knowledge today therapeutic procedure of slipped capital femoral epiphysis is described.