Management of slipped capital femoral epiphysis: Results of a survey of the members of the Paediatric Orthopaedic Society of India (POSI)

Abstract

Aim: To determine the preferred practices in the treatment of slipped capital femoral epiphysis (SCFE) among members of the Paediatric Orthopaedic Society of India (POSI). Materials and Methods: A questionnaire with 16 vignettes was made about SCFE and sent to all members of the Paediatric Orthopaedic Society of India (POSI) to study the similarity and variation in the management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the prevalence of Femoro Acetabular Impingement (FAI) and anticipated need for secondary surgery. Results: The response rate was 94 out of 203 members of Paediatric Orthopaedic Surgeons of India (51.9%). 62 out of 94 (66%) participating surgeons had an exclusive paediatric orthopaedics workload, with 61 surgeons (65%) having more than ten years of experience. Seventy-eight surgeons (83%) were most consistent in their advice for the management of stable slips based on severity. For severe stable slips, 67 surgeons (71%) recommended Modified Dunn procedure. Around 23% of the respondents preferred to do modified Dunn's procedure for all unstable slips while the rest had different approaches to treat this. Single Partially threaded cancellous screw is the preferred implant for in-situ fixation, while a single screw and K wire construct is the preferred construct for in Modified Dunn's procedure. Only 17(16%) of the responders do prophylactic pinning of the opposite hip regularly. Almost 90 responders (96%) do counsel parents about FAI in later stages of life. Conclusion:Our study documents that about 70% of the practising paediatric orthopaedic surgeons prefer to do capital realignment procedure for severe stable slips. The treatment of unstable slips remains controversial without any consensus though about 70% believe that there is a role of gentle reduction or positional reduction or skeletal traction. About 50% of the respondents treat less than five slips a year and thus would not possible to generate high-quality evidence based on meagre numbers. This clearly shows that there is a need for developing a national SCFE registry to pool in all data which would help us to arrive at meaningful conclusions to arrive at the ideal management guidelines for SCFE.

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

“… 7 A higher rate of agreement in the treatment of stable, mild/moderate slips by in-situ fixation, stable, severe slips by capital realignment procedures and a higher variability in the treatment of unstable slips were observed in a survey conducted among the members of the Pediatric Orthopaedic Society of India. 9 In this study, experienced surgeons could not achieve considerable agreement on the optimal treatment of all severe slip scenarios. However, respondents of the present survey strongly agreed on the optimal treatment of all types of mild and moderate slip scenarios.…”

“…26 In the published surveys, less than one-third of the respondents preferred prophylactic screw fixation of the unaffected contralateral hip at the same session. [7][8][9][10]12 In this study, prophylactic screw fixation was only preferred when needed and the existence of an endocrinopathy and younger age were the indicators of prophylactic screw fixation which the respondents had reached a consensus. These findings are compatible with the existing knowledge in the literature.…”

“…6 Up to date, several survey studies about the treatment of SCFE have been published. [7][8][9][10][11][12] The results of these surveys revealed that there was considerable disagreement among the respondents on several aspects of SCFE treatment. However, to our knowledge, a Delphi consensus study on the treatment of all possible SCFE clinical scenarios has not been conducted, yet.…”

Medium-long-term follow-up of slipped capital femoral epiphysis treated with in situ fixation and patient-acceptable symptom state evaluation

“…In recent years, several authors have advocated the transition of surgical strategy for moderate-severe SCFE from in situ fixation (currently the most used method, with or without reduction) to the modified Dunn procedure according to Ganz. This shift has been substantiated either by a reportedly higher incidence of complications in severe cases with the former procedure, or by superior short-and long-term clinical outcomes with the modified Dunn procedure according to Ganz [15][16][17][18][19][20][21][22][23].…”

Controlled repositioning and primary osteoplasty as a treatment option for the management of unstable slipped capital femoral epiphysis

“…There are conflicting views about the management of unstable SCFE [10][11][12]. The goals of treatment in SCFE are to prevent further slip and to achieve an impingement-free, near-normal range of motion without damaging the vascularity of the femoral head.…”