Slipped capital femoral epiphysis in children aged less than 10 years

Slipped capital femoral epiphysis (SCFE) is rare in children aged less than 10 years, and its management in this age group raises a number of different considerations. We present a series of 10 children aged less than 10 years who presented with SCFE to our institution between 1993 and 2005. Case notes and radiographic review were carried out. There were six boys and four girls, with an age range of 5.2-9.9 years. Mean follow-up was 50 months (22-90). The mean duration of symptoms was 54 days (1-196). Five cases were bilateral. The second slip occurred at a mean interval of 14 months (11-22) after the first slip. There were 12 stable and three unstable slips. One child had hypothyroidism and another oculocutaneous albinism. The remaining children had normal genetic and endocrine profiles. Six children were severely obese, one obese, two overweight, and one within the normal range. Multiple pins were used in nine hips and a single cannulated screw was used in six hips. Complications include loss of fixation in five hips treated with multiple pins, which were revised between 2 months and 2 years from the initial surgery, and one superficial wound infection. There were no cases of avascular necrosis or chondrolysis. In conclusion, obesity is closely related to the development of SCFE in younger children. A technique that preserves physeal growth should be used for in-situ fixation. Multiple pins preserve capital femoral physeal growth, but at the cost of a high complication rate. Strong consideration for prophylactic pinning of the contralateral hip is recommended.