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Background Several aspects of slipped capital femoral epiphysis (SCFE) treatment remain controversial. Loder's work has been instrumental in changing our understanding and approach to the management of the condition when he introduced the concept of ''slip instability'' and showed that avascular necrosis (AVN) developed in 47% of unstable slips but none of the stable slips. As the two types of SCFE behave differently in terms of presentation, progress and complications, we approached them as two different conditions to highlight these differences. This paper focuses on treatments of stable SCFE. Materials and methods An extensive literature search was carried out from multiple databases. One thousand six hundred and twenty-three citations were screened. Three hundred and sixteen full publications were obtained for further scrutiny. Fifty-eight studies (2262 hips) were included in the review. These studies evaluated 6 interventions. AVN was chosen as a surrogate for bad outcome. Secondary outcomes were chondrolysis (CL), femoro-acetabular impingement (FAI), osteoarthritis (OA) and patients' reported outcomes. The latter were pooled when they met our predefined criteria. Results The type of surgical intervention was an important risk factor. Pinning in situ (PIS) was associated with the lowest AVN rate (1.4%). Moreover, the CL, FAI and OA rates were relatively low in patients who underwent PIS.

Pain due to intra- and extracapsular hip fractures is usually treated with opioid medication. Paracetamol (acetaminophen in North America) has better bioavailability when given intravenously than orally and has been successfully used in the postoperative care of orthopedic patients. However, no study has evaluated its use in the preoperative trauma patient. Our unit conducted a prospective, consecutive cohort study to investigate the opioid-sparing effect of regularly administered intravenous paracetamol compared with oral paracetamol in preoperative hip fracture patients. The total opioid dose given, based on conversion to intravenous morphine, and the reported pain score were evaluated in 75 patients. There were 28 patients in the control group who were give routine oral paracetamol and oral opioids, with morphine for breakthrough pain. There were 47 patients in the study group who received only routine intravenous paracetamol, with opioids reserved for breakthrough pain. The patients in the 2 groups had similar characteristics. The mean preoperative oral paracetamol dose for the control group was 7.2 g compared with 6.3 g in the study group. There was a significant reduction (P<.005) in the mean total intravenous morphine with intravenous paracetamol (6.5 mg) compared with oral paracetamol (21.8 mg). There was no difference in the mean pain score between the groups, 2.1 vs 1.8 (P=.3). Intravenous paracetamol had a significant opioid-sparing effect and satisfactory pain relief in preoperative hip fracture patients.

Osteogenesis imperfecta is a disorder of abnormality in collagen metabolism due to genetic defects, which causes fragility fracture in children. Fragility fracture of the neck of femur can be difficult to treat in adults. The difficulties increase exponentially in children. The challenge becomes more severe when there is an intramedullary rod in situ in the femoral shaft. It is a technically demanding work to fix fracture caused by osteogenesis imperfecta. There is hardly any published study on the difficult fixation of fracture neck of femur in osteogensis imperfecta. Therefore, we present two cases using cannulated screw fixation for this type of fracture for the benefit of other orthopaedic surgeons.

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The primary objective of this review is to assess the effects of non-operative treatments such as hip spica or traction, and surgical treatments such as pinning in situ and open reduction and fixation for the treatment of slipped upper femoral epiphysis (SUFE). Secondary objectives include; assessing the effects of timing of the surgery on the outcome AVN, assessing the effects of prophylactic fixation of the contralateral unaffected side and finding predictors for development of contralateral slips in patients with SUFE. 1 Interventions for treating slipped upper femoral epiphysis (SUFE) (Protocol)

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