Does treatment with combined pinning and flexion osteotomy in severe type of slipped capital femoral epiphysis reduce the rate of AVN?

Purpose:
No consensus exists regarding treatment of severe type of slipped capital femoral epiphysis (SCFE). Current treatment options range from pinning in situ to modified Dunn osteotomy; however, significant rates of late complications have been described. The purpose of the current study was to evaluate the effectiveness and complication rate of combined pinning and flexion osteotomy in the acute setting.

Method:
From 2014 to August 2021, we treated 11 patients with acute SCFE. Mean age at the time of procedure was 12.6 years (range, 9-15 years). 3 patients had a bilateral chronic condition with unilateral acute on chronic SCFE, one patient had unilateral neglected disease, one had asynchronous bilateral acute disease and six unliteral acute disease. Southwick slip angle was severe (above 50º) in all patients. Treatment protocol included capsulotomy, open reduction by Parsch technique, percutaneous pinning by a screw, flexion osteotomy with derotation and plating of the femur. The contralateral side was treated by pinning in situ when necessary.

Results:
All patients had uneventful healing of the osteotomy within 3 months. At latest follow-up (mean 3 years postoperatively, seven patients had no complications, three had isolated CAM deformity but only one was symptomatic, and one patient developed AVN of the femoral head.

Conclusion:
Based on our experience, this protocol proved to be safe with a minimal rate of complications and relatively good outcome.