A 12-year-old boy with a stable, mild chronic slipped capital femoral epiphysis is haemodynamically fit for surgery. What is the accepted standard definitive treatment?
- A In situ fixation with a single cannulated screw across the physis ✓
- B Immediate gentle closed manipulation and reduction followed by pinning
- C Proximal femoral corrective osteotomy
- D Traction for 3 weeks followed by bed rest until physeal closure
Correct answer: A. In situ fixation with a single cannulated screw across the physis
Explanation
For stable mild and moderate slips, in situ fixation with a single cannulated screw placed perpendicular to the physis through the centre of the epiphysis is the gold standard. It prevents further slippage with minimal complications. Forced manipulation carries a real risk of further damaging the retinacular blood supply and precipitating avascular necrosis, so the existing deformity is left alone unless a significant residual deformity later warrants a corrective osteotomy.
Reference: Lovell and Winter's Pediatric Orthopaedics, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.