Slipped capital femoral epiphysis: complications related to internal fixation

In situ pinning and subtrochanteric osteotomy have been widely used in the operative treatment of slipped capital femoral epiphyses. A review of all operative procedures performed at Children's Orthopedic Hospital in Seattle, Washington from 1960 to 1982 was performed. In the 85 consecutive cases, there were 66 pinning procedures with a 30% incidence of pin penetration. In 18 cases of attempted pin removal, there was major difficulty in 11 (61%). In 1 3 cases of subtrochanteric osteotomy, there was a significant incidence of infection, chondrolysis, and implant complication with fair to good clinical results in 11 cases. From this series the author concludes that in situ pinning is technically difficult and that two pins are adequate. Hagie or Moore pins should not be used, because of difficult pin removal. Anterior bone graft epiphysiodesis may be the procedure of choice for slips of more than 35° to 40°. Key indexing terms: slipped capital femoral epiphysis, slipped epiphysis, internal fixation, in situ pinning, subtrochanteric osteotomy.