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Slipped capital femoral epiphysis: is prophylactic pinning more effective at reducing complications than follow-up?
  1. Rachel E. Thompson1,
  2. Bhavesh V. Tailor2
  1. 1 School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2 Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Rachel E. Thompson, School of Clinical Medicine, University of Cambridge, Cambridge, UK; ret47{at}cam.ac.uk

https://doi.org/10.1136/archdischild-2020-320695

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    Clinical bottom line

    • Following unilateral slipped capital femoral epiphysis, prophylactic fixation of the contralateral hip reduces the risk of subsequent slip and associated avascular necrosis (Grade C).

    • Prophylactic pinning of the contralateral hip carries a low risk of perioperative and short-term complications when fixation is carried out using a single cannulated screw (Grade C).

    • Data are lacking for complications of prophylactic fixation in adulthood, making long-term comparison of follow-up and prophylactic pinning difficult (Grade D).

    Clinical scenario

    An 11-year-old girl presents to the limping child clinic with a 4-week history of left groin pain. Examination is painful and reveals restricted internal rotation and flexion of the left hip. A radiographic series of anteroposterior and frog-lateral views shows a unilateral slipped capital femoral epiphysis (SCFE). On referral to the orthopaedic team to organise surgical fixation, the orthopaedic registrar on call comments that the patient’s treatment is likely to vary considerably depending on the surgeon operating, each having a personal preference for or against prophylactic pinning of the contralateral hip. You wonder how prophylactic fixation might affect patient outcomes.

    Question: For children diagnosed with unilateral SCFE (patient), is prophylactic fixation of the contralateral hip (intervention) more effective …

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    Footnotes

    • Contributors RT: conception, literature search, manuscript composition, review of drafts and implementation of changes. BVT: manuscript composition, review of drafts and implementation of changes.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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