In slipped capital femoral epiphysis (SCFE), which classification system guides immediate operative urgency and determines prognosis by categorising slips based on the ability of the patient to bear weight?
- A Loder classification — stable (able to weight-bear with or without crutches) versus unstable (cannot weight-bear) ✓
- B Wilson's classification — acute (<3 weeks), chronic (>3 weeks), or acute-on-chronic
- C Southwick classification — mild (<30°), moderate (30–60°), severe (>60°) based on head-shaft angle
- D Delbet classification — graded by degree of physeal disruption on MRI
Correct answer: A. Loder classification — stable (able to weight-bear with or without crutches) versus unstable (cannot weight-bear)
Explanation
Loder's classification (1993) divides SCFE into stable (patient can weight-bear, with or without crutches) and unstable (unable to weight-bear even with crutches). Unstable SCFE carries AVN risk of up to 47% compared to <1% in stable slips, necessitating urgent surgical fixation (in-situ pinning). The duration-based classification (acute/chronic/acute-on-chronic) is older and less clinically useful for prognosis. Southwick angle classifies slip severity but not urgency. Loder classification thus determines both surgical timing and prognosis discussion.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.