Slipped capital femoral epiphysis: pathomechanism, clinical presentation, diagnosis, natural history and treatment. A review of the literature.

Slipped capital femoral epiphysis (SCFE) occurs in preadolescent and adolescent children. The exact pathomechanism of the slip is not known. Several risk factors have been identified including hormonal derangement. Of the classification systems, stability and severity classification systems are most relevant to everyday practice. There is a strong agreement regarding the management of a mild slip. Controversies exist in the treatment of moderate and severe slips and also regarding the prophylactic pinning of the opposite side. Discrepancies exist amongst countries and surgeons as to the number of screws to be used for pinning. Increasing evidence of femoroacetabular impingement as a cause of osteoarthritis of the hip may change the treatment of moderate and severe slips in the future. The modified Dunn procedure may become a standard procedure in the future to treat moderate and severe slips; however, experience and accurate knowledge of surgical anatomy is required for good outcomes following this procedure.