Loder SCFE stability

Acute slipped capital femoral epiphysis: the importance of physeal stability.

Loder RT, Richards BS, Shapiro PS, et al. The Journal of bone and joint surgery. American volume 1993 · PMID 8354671 · doi:10.2106/00004623-199308000-00002

Question

Does the ability to weight-bear (physeal stability) predict avascular necrosis in acute SCFE?

Design

Retrospective review of acute slips (symptoms under 3 weeks) reclassified by physeal stability.

Patients

Children with acute slipped capital femoral epiphysis, all treated with internal fixation.

Intervention

Classification as stable (able to weight-bear) or unstable (unable to weight-bear even with crutches)

Comparison

Stable versus unstable slips

Primary outcome

Avascular necrosis of the femoral head

Key result

Avascular necrosis developed in almost half of unstable slips and in none of the stable slips, and satisfactory results were far more frequent in stable hips; early reduction was not shown to be linked to AVN.

Limitations

Retrospective design with heterogeneous treatments across centres and relatively small numbers of unstable slips.

Impact on practice

The Loder stable/unstable classification is the standard way SCFE is classified in the UK, and unstable slips are treated as urgent with counselling about high AVN risk.