It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.

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Purpose Unstable slipped capital femoral epiphysis is rare, but is frequently associated with avascular necrosis. The rapid and complete reduction of the epiphysis displacement was shown to be responsible for this complication. We present the preliminary results of a progressive reduction technique of epiphysis displacement. Methods A total of 11 patients treated using progressive traction and internal fixation were reviewed retrospectively. Only children who underwent clinical and radiological follow-up for at least 18 months were included in this study to detect avascular necrosis. Results The mean posterior displacement of the femoral head was 67°and mean traction duration was 13 days. Of the patients, 2 had cutaneous problems requiring traction interruption, one on day 5 and the other on day 9. The mean residual slip was 16°and 3 patients had complete or partial avascular necrosis well tolerated at the final follow-up. Conclusion Our experience showed that if traction is supported for more than 2 weeks, a good correction of the epiphysis displacement can be obtained. Our short series does not allow affirmation of the superiority of our therapeutic strategy, especially with regards to avascular necrosis of the femoral head.