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SUFE Key Paper 1

Loder, R. T., Richards, B. S., Shapiro, P. S., Reznick, L. R., Aronson, D. D.
The Journal of Bone and Joint Surgery, VOL. 75-A, NO. 8, AUGUST 1993, pp. 1134-1140
Department of Orthopaedic Surgery, Children's Hospital of Michigan, Wayne State University, Detroit. The Section of Orthopaedic Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor. The Texas Scottish Rite Hospital, Dallas.

ABSTRACT: To test the traditional classification system of slipped capital femoral epiphysis, we evaluated the presenting symptoms and radiographs of fifty-four patients and reclassified the slipped epiphyses as unstable or stable, rather than acute, chronic, or acute-on-chronic. Slips were considered to be unstable when the patient had such severe pain that weight-bearing was not possible even with crutches. Slips were considered to be stable when the patient could bear weight, with or without crutches. 
We reviewed the records on fifty-five hips in which the slip would have been classified as acute because the duration of symptoms was less than three weeks; thirty of these were unstable and twenty-five were stable. All slips were treated with internal fixation. A reduction occurred in twenty-six of the unstable hips and in two of the stable hips. Fourteen (47 per cent) of the thirty unstable hips and twenty-four (96 per cent) of the twenty-five stable
hips had a satisfactory result. Avascular necrosis developed in fourteen (47 per cent) of the unstable hips and in none of the stable hips. We were not able to demonstrate an association between early reduction and the development of avascular necrosis. 

Introduction

Slipped capital femoral epiphysis, a disorder affecting adolescents, traditionally has been classified on the basis of the duration of symptoms. A slip has been defined as acute when there was a sudden onset of usually severe symptoms and the symptoms were of less than three weeks' duration {11,19}. Some authors {8,11}, however, have used two weeks for this definition. Aadelen et al stated that a gentle reduction, done with the patient under general anesthesia, must be at least partially successful for a slip to be defined as acute. A chronic slip has been characterized by the gradual onset and progression of symptoms for more than three weeks, without any sudden exacerbation. A combination of these two groups, or acute-on-chronic slips, has been characterized by the sudden exacerbation of symptoms due to acute displacement of an already chronically slipped epiphysis. More recently {2,26}, the sudden onset of severe pain in the hip without radiographic signs of remodeling and new-bone formation at the epiphyseal-metaphyseal junction has been used as the definition of an acute slip and radiographic signs of periosteal new bone, of a chronic slip.



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