الفهرس 
Pathoanatomy and Biomechanics of SCFEOnly 14 pages are availabe for public view
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Abstract
Slipped capital femoral epiphysis (SCFE) is still the most common hip disorder affecting adolescents with an estimated incidence of 1 to 24.6 per 100,000 children between the ages of 8 and 15, with a prevalence of asymptomatic so-called silent SCFE of 3% in girls and 10% in boys.22,23,24
In orthopedic literature, there is little consensus regarding the best management of slipped capital femoral epiphysis (SCFE). Controversies and disparate trends derive from differences in clinical presentation, various classifications, and a variety of surgical procedures that have been described. Surgical procedures vary, and they can be divided into fixation in situ, compensatory osteotomies, and direct corrections of the deformity at the head–neck junction. The first and second group of procedures have so far not gained optimal control over the risk of avascular necrosis or cannot achieve an anatomically aligned epiphysis with normal blood supply. On the other hand, the third technique can achieve this target and prevent residual deformity and the development of early hip arthritis, but it is not widely accepted, because of its surgical complexity.
The open reduction of slipped capital femoral epiphysis aims to relocate the capital femoral epiphysis while minimizing the risk of avascular necrosis by preserving blood vessels to the epiphysis.2 The procedure can be done in a variety of ways Most involve a wedge-shaped osteotomy of the femoral neck. Surgical hip dislocation (SHD) is a versatile approach used to address both intra-articular and extra-articular pathology around the hip joint.2
The modified Dunn procedure through a surgical dislocation approach is gaining popularity for the treatment of the acute unstable slips. The technique adopts lateral trans trochanteric approach and a second trochanteric osteotomy in order to develop an extended retinacular flap. Open reduction of unstable slips is the best indication for SHD in patients with SCFE. It is difficult from the literature to establish absolute recommendations for treatment.39 Currently, there are no evidence-based recommendations. However, the literature supports 2 specific indications for anatomic reduction of the slip by SDH: acute/unstable SCFE and chronic SCFE (with open physis).
Advocates of the modified Dunn procedure believe this technique is indicated in chronic SCFE with more than 30◦ of slippage.39 In cases with moderate and severe SCFE treated with in situ pinning, many are left with substantial residual deformity of the proximal femur that leads to alterations in gait, significant limitation of hip motion, and chronic pain.39 In severe SCFE, osteochondroplasty on its own may not be sufficient to restore a normal head-neck offset or, on the other hand, it bears the risk of an iatrogenic femoral neck fracture if too much bone is removed.136 Increased motion due to remodeling is not a preferable advancement but rather changes the impingement mode from impaction to inclusion, which is more deleterious for the joint cartilage.48
Recently, the largest systematic review of the treatment of unstable slips confirmed that instability was an important risk factor for AVN. It also suggested that open reduction and internal fixation seem to be associated with less AVN than other interventions (scoring similar rates in moderate and severe slips). Surgery should be performed ideally within 24 hours from presentation, and if this is not possible, delaying the operation to >72 hours may be associated with less AVN.136
The future of Hip joint preservation should be directed towards the development of the treatment of chondrolabral injuries. The more we know, the more we should go towards prophylactic operative treatment, because we know if there is damage, we will not return to point 0. We never do. (GANZ) Surgical hip dislocation (SHD) is a versatile approach used to address both intra-articular and extra-articular pathology around the hip joint.2
In conclusion Sub capital re-alignment is the centerpiece of a treatment concept for SCFE and as such is gaining increasing acceptance.12 According to literature, “This is one of the most exciting developments in the entire field of hip pathology, hip disease and the surgical management of hip disease in the last decade.”.92 In agreement with recent studies, it may be affirmed that the modified Dunn procedure is safe, efficient, and reproducible. Surgeon experience with this procedure is a determining factor of the outcome.