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Lack of reduction prior to fixation
10%
302/2971
Single screw fixation
9%
269/2971
Female sex
2%
68/2971
Inability to bear weight preoperatively
71%
2108/2971
Obesity
7%
211/2971
Select Answer to see Preferred Response
The patient presents with femoral head osteonecrosis (Figure B), following in-situ screw fixation of a severe SCFE (Figure A). The inability to bear weight, even with assistive devices, preoperatively indicates an unstable SCFE, which is associated with significantly increased rates of osteonecrosis. Kennedy et al retrospectively reviewed the rates of osteonecrosis for patients with stable and unstable SCFEs at a single institution. Patients identified as having an unstable SCFE based on the clinical criteria of inability to bear weight were found to have significantly increased risk for development of osteonecrosis (4 of 27 patients). None of the patients with stable slips had evidence of osteonecrosis (0 of 272 patients). In their review of the management of slipped capital femoral epiphysis, Aronsson et al state that those patients with an unstable SCFE may have rates of osteonecrosis as high as 50%. Patient with a stable SCFE have rates of osteonecrosis of 0-5%. Incorrect Answers: Answer 1: In-situ screw fixation of unstable SCFE has not been show to be a risk factor for osteonecrosis. Answer 2: Fixation with a single screw, although less stable than alternative methods, does not lead to increased risk of osteonecrosis. Answer 3: Sex is not predictive of rates of osteonecrosis. Answer 5: Obesity is not associated with osteonecrosis
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