Evidence brief
Slipped Capital Femoral Epiphysis: Surgical Treatment
Stable vs unstable classification based on ability to weight bear
Unstable SCFE has 50% AVN risk
In situ pinning is standard treatment for stable SCFE
Urgent surgery for unstable SCFE controversial
Prophylactic contralateral pinning debated
Loder classification distinguishes stable from unstable SCFE, which has major prognostic implications. Treatment aims to prevent further slip and minimize AVN risk.
Stable = can weight bear; unstable = cannot weight bear. In situ pinning for stable slip. Unstable: emergent surgery controversial (some advocate decompression). Know technique: single central screw, stop before subchondral bone. Discuss prophylactic contralateral pinning indications.
Loder RT et al. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993;75(8):1134-1140.
Level III
Retrospective comparative study or case-control study