Primary prevention

Weight management and dietetic measures to control adolescent obesity may help minimize the likelihood of developing the disorder.

Secondary prevention

Although many surgeons employ a low threshold for prophylactic fixation of the contralateral hip in pathologic SCFE (underlying metabolic disorder or endocrinopathy), there is no consensus in idiopathic SCFE.

Many variables have been investigated to predict subsequent SCFE in unilateral idiopathic SCFE.

These include:[36]

  • Sex of patient

  • Symptom duration

  • Obesity

  • Trauma

  • Severity of index slip

  • Laterality

  • Patient age

  • Modified Oxford bone score

  • Bone age.

The posterior sloping angle (PSA), defined as the angle between the line along the plane of the physis and the line perpendicular to the femoral neck-diaphyseal axis on axial radiograph, has been shown to be predictive of a contralateral slip in patients presenting with unilateral SCFE.[37] In one study, PSA was more predictive in girls; the authors recommended prophylactic pinning with a PSA >13.[37] According to one meta-analysis, younger patients with a high PSA of the unaffected hip are those most likely to benefit from prophylactic fixation.[36]

Prophylactic pinning is likely to be beneficial for the long-term outcome of contralateral SCFE in some cases where underlying metabolic disorders are present. However, clinicians should consider each case on its own merits before offering prophylactic intervention.

Implant removal

Implant removal is sometimes necessary but has a significant complication rate. The decision to remove implants should be performed on a case-by-case basis due to the high complication rate. In an evidence-based analysis of removal of orthopedic implants in the pediatric population, the complication rate for SCFE implant removal was 34%, while the complication rate from all reported pediatric orthopedic implants excluding that from SCFE patients was 6%.[52]

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