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. 2019 Nov;78(11 Suppl 2):21-25.

Management of Slipped Capital Femoral Epiphysis: The Hawai'i Experience

John P Livingstone  1 , Mariya I Opanova  1 , Robert C Durkin  2 , William Burkhalter  2
Affiliations

Management of Slipped Capital Femoral Epiphysis: The Hawai'i Experience

John P Livingstone et al. Hawaii J Health Soc Welf. 2019 Nov.

Abstract

Slipped capital femoral epiphysis (SCFE) is a growing problem amongst children in Hawai'i as well as throughout the world. With increasing rates of childhood obesity, SCFEs are affecting more patients at younger ages. This makes the treatment of SCFEs critical as many children with SCFEs have significant growth remaining. There are a host of treatment options based on different classification schemes which can make it difficult to determine the appropriate care for a SCFE patient. In our practice, patients are treated based on a combination of angular displacement, stability as defined by Loder, and patient age. The procedures vary from single screw in-situ fixation for a mild deformity to a modified Dunn procedure for a high-grade deformity in the skeletally immature patient. For all our open fixation methods, epiphyseal perfusion is monitored with an 18-gauge needle attached to an arterial monitor and we routinely remove fixation after physeal closure. Excellent outcomes have been noted for the modified Dunn in our practice. This article describes the algorithm used to treat SCFE in Hawai'i at a tertiary children's medical center.

Keywords: Hawai‘i; arterial perfusion; gliding; growing; intertrochanteric osteotomy; intraoperative monitoring; modified dunn; obesity; pacific island; screw fixation; slipped capital femoral epiphysis.

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Conflict of interest statement

None of the authors identify any conflicts of interest.

Figures

Figure 1.
Figure 1.
Photo demonstrating the Southwick angle of a left SCFE.
Figure 2.
Figure 2.
2a: Algorithm for Treating Unstable SCFE. 2b: Algorithm for Treating Stable SCFEs.
Figure 3.
Figure 3.
Synthes In-Situ SCFE Screw
Figure 4.
Figure 4.
Pega Gliding Screw
See this image and copyright information in PMC

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