Traction reduction of acute and acute-on-chronic slipped capital femoral epiphysis.

Gentle reduction of acute or the acute portion of acute-on-chronic severe slipped capital femoral epiphyses (SCFE) is generally recommended. Reports of the use of longitudinal traction with medial rotation traction, although few, are uniform in describing a high rate of success with rare complications. Of 30 acute or acute-on-chronic SCFEs examined at the author's institution between 1970 and 1990, 13 underwent attempted traction reduction with longitudinal traction and medial rotation. Only five of these 13 hips had discernible reduction. One of these five hips developed aseptic necrosis; however, this hip was clearly distracted from the acetabulum by excessive longitudinal traction that may have contributed to the development of osteonecrosis. One of the seven hips that failed traction reduction developed aseptic necrosis, and one of the 17 acute SCFEs pinned in situ developed aseptic necrosis. All three hips developing necrosis were in a group of 14 hips with moderate to severe SCFEs and complete inability to bear weight with severe pain.