{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T04:18:23Z","timestamp":1748319503636,"version":"3.41.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>The ideal management of an unstable slipped capital femoral epiphysis (SCFE) is still controversial. The currently available options are in-situ screw fixation with delayed corrective osteotomy, closed reduction and screw fixation and anatomic reduction by modified Dunn\u2019s procedure (MDP). We present the results of our technique of controlled re-positioning (CRP) with primary osteoplasty in which the epiphysis is repositioned to the preacute slip stage and a mini-open osteoplasty is done in the same sitting to avoid later femoro-acetabular impingement. We had 27 unstable slips which presented to our institution between 2015 and 2019, of which nine were treated with the above technique, and the rest 18 were treated with MDP. All of them were followed up for a minimum of 1\u2009year. The mean intraoperative flexion-internal rotation before osteoplasty was \u221221.1\u00b0 (\u22125\u00b0 to \u221240\u00b0), which improved to +22.8\u00b0 (+15\u00b0 to +30\u00b0). Pre- and post-operative mean head-neck angles were 46.5\u00b0 and 18.3\u00b0, respectively, with a decrease of 28.2\u00b0. At the final follow-up, the mean alpha angle was 45.1\u00b0 and the mean head-neck offset ratio was 0.26. None of the patients had avascular necrosis or chondrolysis. The technique of CRP, screw fixation and primary osteoplasty is a viable treatment option for a subset of patients with unstable SCFEs. But, the decision is made intraoperatively and the parents need to be counselled about the need for an alternative procedure if repositioning is unsuccessful. Level of evidence: level IV \u2013 case series.<\/jats:p>","DOI":"10.1097\/bpb.0000000000000930","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T07:00:52Z","timestamp":1653634852000},"page":"359-364","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Controlled repositioning and primary osteoplasty as a treatment option for the management of unstable slipped capital femoral epiphysis"],"prefix":"10.1097","volume":"31","author":[{"given":"K.","family":"Venkatadass","sequence":"first","affiliation":[{"name":"Department of Orthoapedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V. Durga","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Orthoapedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Sangeet","sequence":"additional","affiliation":[{"name":"Department of Orthoapedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Orthoapedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2022,5,24]]},"reference":[{"key":"R1-20250526","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.2106\/00004623-199308000-00002","article-title":"Acute slipped capital femoral epiphysis: the importance of physeal stability.","volume":"75","author":"Loder","year":"1993","journal-title":"J Bone Joint Surg Am"},{"key":"R2-20250526","doi-asserted-by":"crossref","first-page":"798","DOI":"10.2106\/00004623-200305000-00004","article-title":"Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis.","volume":"85","author":"Tokmakova","year":"2003","journal-title":"J Bone Jt Surg Am"},{"key":"R3-20250526","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/BPO.0b013e3181e4f372","article-title":"The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis.","volume":"30","author":"Sankar","year":"2010","journal-title":"J Pediatr Orthop"},{"issue":"Suppl 1","key":"R4-20250526","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1097\/BPO.0000000000000295","article-title":"Acute, unstable, slipped capital femoral epiphysis: is there a role for in situ fixation?","volume":"34","author":"Wenger","year":"2014","journal-title":"J Pediatr Orthop"},{"key":"R5-20250526","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2106\/JBJS.L.00203","article-title":"The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective.","volume":"95","author":"Sankar","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"R6-20250526","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/01241398-200103000-00011","article-title":"Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis.","volume":"21","author":"Kennedy","year":"2001","journal-title":"J Pediatr Orthop"},{"issue":"Suppl 1","key":"R7-20250526","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1097\/BPO.0b013e318277172e","article-title":"What is the cause of avascular necrosis in unstable slipped capital femoral epiphysis and what can be done to lower the rate?","volume":"33","author":"Loder","year":"2013","journal-title":"J Pediatr Orthop"},{"key":"R8-20250526","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2106\/00004623-200402000-00049","article-title":"Reduction increasing osteonecrosis risk in slipped capital femoral epiphysis.","volume":"86","author":"Narayanan","year":"2004","journal-title":"J Bone Jt Surg"},{"key":"R9-20250526","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1302\/0301-620X.84B8.0841176","article-title":"Anterior physeal separation. A sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis.","volume":"84","author":"Ballard","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"R10-20250526","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/01.bpo.0000151058.47109.fe","article-title":"Management of unstable\/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership.","volume":"25","author":"Mooney","year":"2005","journal-title":"J Pediatr Orthop"},{"key":"R11-20250526","doi-asserted-by":"crossref","first-page":"S553","DOI":"10.1016\/j.jcot.2020.04.029","article-title":"Management of slipped capital femoral epiphysis: results of a survey of the members of the Paediatric Orthopaedic Society of India (POSI).","volume":"11","author":"Sivakumar","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"R12-20250526","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/01.bpb.0000236234.64893.92","article-title":"Current practice in the management of acute\/unstable slipped capital femoral epiphyses in the United Kingdom and the Netherlands: results of a survey of the membership of the British Society of Children\u2019s Orthopaedic Surgery and the Werkgroep Kinder Orthopaedie.","volume":"16","author":"Witbreuk","year":"2007","journal-title":"J Pediatr Orthop B"},{"key":"R13-20250526","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.arthro.2014.05.024","article-title":"Arthroscopic femoral neck osteoplasty in slipped capital femoral epiphysis.","volume":"30","author":"Chen","year":"2014","journal-title":"Arthroscopy"},{"key":"R15-20250526","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1302\/0301-620X.54B4.607","article-title":"Reduction of acutely slipped upper femoral epiphysis.","volume":"54","author":"Casey","year":"1972","journal-title":"J Bone Joint Surg Br"},{"key":"R16-20250526","doi-asserted-by":"crossref","first-page":"667","DOI":"10.2106\/00004623-199173050-00004","article-title":"Long-term follow-up of slipped capital femoral epiphysis.","volume":"73","author":"Carney","year":"1991","journal-title":"J Bone Joint Surg Am"},{"key":"R17-20250526","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.2106\/00004623-197456070-00016","article-title":"Acute slipped capital femoral epiphysis.","volume":"56","author":"Aadalen","year":"1974","journal-title":"J Bone Joint Surg Am"},{"key":"R18-20250526","doi-asserted-by":"crossref","first-page":"398","DOI":"10.2106\/00004623-199603000-00011","article-title":"Acute slipped capital femoral epiphysis. 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