Slipped capital femoral epiphysis in children.

Two new classification schemes have been described for slipped capital femoral epiphysis (SCFE); both involve the question of stability and are probably more prognostic than the traditional acute or chronic classification. The prevalence of bilaterality is approximately 33%, and two recent series regarding bilateral SCFE recommend frequent follow-up after a child presents with a unilateral SCFE, but they do not recommend prophylactic pinning of the normal hip. In the case of a child with an underlying endocrine disorder who presents with a unilateral SCFE, however, strong consideration should be given to prophylactic pinning of the opposite hip. The most commonly accepted method of fixation at this time is in situ pin fixation with a single central screw. The screw head should be no more than 1.5 cm from the cortex of the femur to prevent windshield-wiper loosening. Chondrolysis, a complication of both untreated and treated SCFE, has a more favorable prognosis than idiopathic chondrolysis.