الفهرس 
Pathogenesis of SCFEOnly 14 pages are availabe for public view
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Abstract
To provide a framework for future studies on the treatment of SCFE, there is a need to review and analyze the current literature and clinical evidence regarding the treatment of this disorder.[50]
Treatment modalities:
An algorithm outlining the assessment and care of stable slips help provide orthopaedic surgeons practical guidelines in selecting their optimal surgical approach in the treatment of a stable SCFE.[18]
At initial presentation, most surgeons treat mild slips with in situ screw stabilization. On occasion, it may be appropriate to additionally perform an osteochondroplasty.[18]
Follow up assessment of the patients is critical to assure that performing appropriate secondary reconstructive procedures are carried out so in a timely manner, before the unnecessary occurrence of early degenerative pathology of the involved hip.[18]
Additional procedures that might subsequently be performed include a PFO, osteoplasty, and possibly a modified Dunn’s procedure through SHD. Surgical strategies including initial and as indicated subsequent reconstructive procedures will notably vary with a surgical expertise.[18]
Alternatively, following slip stabilization, referral may be considered in achieving an optimal surgical approach in the correction of residual potential problematic slip deformities.[18]
For moderate and severe unstable slips, surgical hip dislocation followed by subcapital realignment has been proposed to address the metaphyseal prominence and prevent impingement.[36]
SCFE Complications:
• Avascular necrosis.
• Chondrolysis.
• Femoroacetabular impingement FAI.
• Osteoarthritis.
Results of treatment modalities:
In 2013, study by Wiemann et al. demonstrated that the true magnitude of the deformity in the oblique plane can be accurately and reliably measured with little inter- and intraobserver variability.[27]
Some surgeons advocate a more proactive approach to treat SCFE-related impingement. Scientists argue SCFE should be viewed as a two-fold problem of physeal instability and FAI. It is critical to secure the unstable physis, but the FAI inherent in SCFE must also be addressed.[34]
Since 2008, mild slips are managed with in situ fixation and immediate arthroscopic head-neck osteoplasty; moderate and severe slips are treated with subcapital realignment.[34]
This led scientists to recommend arthroscopic femoral neck osteoplasty after in situ screw fixation for the mild and moderate slips when they showed obligatory external rotation of the hip in flexion. Modified Dunn’s osteotomy through SHD was recommended for more severe slips when osteoplasty will not relieve impingement.[37]
Gourineni et al. modified the in situ screw placement technique initially to allow adequate resection of the anterior femoral neck prominence without risking screw failure.[37]
Oblique in situ screw fixation of stable slipped capital femoral epiphysis did not have any disadvantages and seemed to have several benefits.[37]
SCO as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE.[29]
Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population.[29]
Surgical dislocation and osteoplasty can also be combined with intertrochanteric valgus/flexion osteotomy. In a series, five out of six patients receiving the combined approach had improvement in symptoms after one year. This allows for concomitant restoration of the femoral head weight-bearing surface and resolution of femoral neck impingement.[27]