Role of osteotomy in the treatment of slipped capital femoral epiphysis.

The treatment of severe slipped capital femoral epiphysis (SCFE) remains problematic. Treatment of most mild and moderate cases has been simplified, not by our increasing knowledge of physiology or molecular genetics, but by the advances in radiographic imaging, metallurgy, and the development of cannulated screw technology. Most centers agree that the placement of a single pin or screw across the center of the epiphysis, stabilizing the unreduced epiphysis and keeping the implant out of the joint space until physeal closure is achieved, is the most efficient and effective method for the majority of slips. Despite this knowledge and improvement in early results, the problems of avascular necrosis and chondrolysis have not been eliminated. Of more concern for patients whose severe unreduced SCFE has been pinned in situ is the secondary problem of the altered biomechanics of the lower extremity, leaving the hip in extension, the limb externally rotated and shortened. Most series show poor long-term results of realignment osteotomies; however, most series also show poor long-term results of severe slips treated by any means. These population groups are historically the same. Current radiographic imaging and implant design may eliminate most of the technical problems encountered with the accuracy and stability of realignment osteotomies, thereby allowing earlier motion, which may improve our results. The current status of realignment osteotomies is reviewed.