Opinion survey of members of British Society of Children's Orthopaedic Surgery related to specific case scenarios in slipped capital femoral epiphysis

Abstract

The aim of this study was to assess contemporary management of slipped capital femoral epiphysis (SCFE) by surveying members of the British Society of Children's Orthopaedic Surgery (BSCOS). A questionnaire with five case vignettes was used. Two questions examined the timing of surgery for an acute unstable SCFE in a child presenting at 6 and 48 h after start of symptoms. Two further questions explored the preferred method of fixation in mild and severe stable SCFE. The final question examined the management of the contralateral normal hip. Responses were entered into an Excel spreadsheet and the data was analysed using a χ-test. The response rate was 56% (110/196). Overall, 88% (97/110) responded that if a child presented with an acute unstable SCFE within 6 h, they would treat it within 24 h of presentation, compared with 41% (45/110) for one presenting 48 h after the onset of symptoms (P<0.0001). Overall, 53% (58/110) of surveyed BSCOS members would offer surgery for an unstable SCFE between 1 and 7 days after onset of symptoms. Single screw fixation in situ for mild stable SCFE was advocated by 96% (106/110) with 71% (78/110) using this method for the treatment of severe stable SCFE. Corrective osteotomy is used by 2% (2/110) and 25% (28/110) of respondents for mild and severe stable SCFE, respectively (P<0.0001). Surgeons preferring osteotomy are more likely to perform an intracapsular technique. Prophylactic fixation of the contralateral normal hip was performed by 27% (30/110) of respondents. There are significant differences in opinions between BSCOS members as to the optimal management of SCFE. This reflects the variable recommendations and quality in the current scientific literature. Further research is therefore required to determine best practice and enable consensus to be reached.