The management of unstable slipped capital femoral epiphysis is controversial with variable rates of avascular necrosis (AVN). Treatment options include in-situ stabilization, gentle/positional reduction and screw fixation and modified Dunn’s procedure (MDP). We present a technique of controlled repositioning (CRP) of the epiphysis to pre-acute slip stage, screw fixation and primary osteoplasty. Between 2015 and 2020, 38 unstable slips were treated in our institution. Of these, 14 underwent successful CRP and the rest were treated with MDP. All the 14 patients who had CRP and completed 1-year follow-up were included for this study. The head–neck angle (HNA) was measured at presentation and alpha angle, head–neck offset and AVN were assessed during follow-up. The average age was 14 years (9–18) and mean follow-up was 17.7 months (12–43). The average intraoperative flexion internal rotation before osteoplasty was −18.5° (−40° to −5°) which improved to +22.1° (+15° to +30°). The average preoperative HNA was 48.7° (34.1° to 70.7°) which improved to 18.4° (1.8° to 35.7°) post-operatively. At final follow-up, the average alpha angle and head–neck offset were 46.4° (30.9° to 64.6°) and 0.22 (0.09 to 0.96), respectively. The AVN rate in the CRP group was 7.1% compared with 20.8% in the MDP group, which was not significant (P = 0.383). Two patients had screw breakage. CRP, screw fixation and mini-open primary osteoplasty is a feasible treatment option in a subgroup of patients with unstable SCFEs. The limitation with this technique is that the final decision is made intraoperatively, and hence the patient and parents need to be counselled and consented appropriately. Level of evidence: Level IV—Case series.

中文翻译：

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控制复位和微型开放式一期骨成形术在治疗不稳定的股骨骨骺滑脱中有作用吗？

不稳定股骨骨骺滑脱的处理因缺血性坏死 (AVN) 发生率的不同而存在争议。治疗选择包括原位稳定、轻柔/体位复位和螺钉固定以及改良 Dunn 手术 (MDP)。我们提出了骨骺的受控复位 (CRP) 技术到急性滑动前阶段、螺钉固定和初次骨成形术。2015 年至 2020 年，我院治疗不稳定滑倒 38 例。其中，14 名接受了成功的 CRP，其余接受了 MDP 治疗。所有 14 名患有 CRP 并完成 1 年随访的患者都被纳入本研究。在就诊时测量头颈角 (HNA)，并在随访期间评估 α 角、头颈偏移和 AVN。平均年龄为 14 岁 (9–18)，平均随访时间为 17.7 个月 (12–43)。骨成形术前平均术中屈曲内旋为-18.5°（-40°至-5°），改善至+22.1°（+15°至+30°）。平均术前 HNA 为 48.7°（34.1° 至 70.7°），术后改善至 18.4°（1.8° 至 35.7°）。在末次随访时，平均 α 角和头颈偏移分别为 46.4°（30.9° 至 64.6°）和 0.22（0.09 至 0.96）。CRP组的AVN发生率为7.1%，MDP组为20.8%，差异无统计学意义（P=0.383）。两名患者出现螺钉断裂。CRP、螺钉固定和微型开放式原发性骨成形术是不稳定 SCFE 患者亚组的可行治疗选择。这种技术的局限性在于，最终决定是在术中做出的，因此需要适当地咨询患者和父母并征得他们的同意。证据等级：