O1076: Immediate versus Semi-elective Treatment of Slipped Capital Femoral Epiphyses

Background: Timing of fixation of slipped capital femoral epiphysis (SCFE) is controversial. As pressure mounts to limit inpatient admissions and procedures, we wished to investigate whether treatment of SCFE in a delayed manner is a safe alternative. Our hypothesis was that there would be no difference in long-term complications for immediate (24 hours) slips treated with open or percutaneous fixation.

Methods: A retrospective review of a prospectively-collected database was performed at 2 academic institutions yielding 126 patients and 151 slipped epiphyses (8 bilateral and 17 had delayed contralateral slips) with an average follow up of 18 months. Between-group analysis was performed with chi-square and one-way analysis of variance (ANOVA).

Results: Of the 151 epiphyses, 123 (81%) were stable SCFE and 147 (97%) were treated with percutaneous pinning using 7.3 mm cannulated screws. After exclusion of 4 slips with surgical delay >100 days, fixation of SCFE were treated at an average of 1.6 days (95% CI 0 6.2 days). Nineteen (12.5%) slips experienced complications (7 multifactorial, 5 isolated impingement, 4 hardware-related, 3 isolated AVN or chondrolysis, 1 limb length discrepancy). There was no difference in complication rate of patients who were treated immediately (14/105 pts, 13%) or delayed (5/46, 11%) manner (p=0.79). The overall rate of complications among unstable slips was 18% (5 of 28) and within this group, a one-way ANOVA demonstrates no difference in time to treatment between those unstable slips with and without complications (0.2 vs 0.71 days, p=0.51).

Conclusion: There was found to be no difference in complication rate between those SCFE treated in an immediate or delayed timing (13% vs 11%, p=0.79) and there was no difference in timing to fixation between groups.This result was consistent in a small subgroup (n=28) of unstable slips with and without complications.