In slipped capital femoral epiphysis, what is the recommended urgent management to prevent avascular necrosis?

• A. Urgent in-situ pinning or stabilization to prevent AVN; avoid forceful manipulation
• B. Immediate open reduction with forceful manipulation
• C. Observation with restricted activity
• D. Intra-articular corticosteroid injection

Answer: (A)

In slipped capital femoral epiphysis, the priority is to stop the slip and preserve the femoral head’s blood supply. The best urgent management is in-situ stabilization with a percutaneous screw or pin across the physis to hold the epiphysis in its current position. This approach prevents further displacement while minimizing disruption to the retinacular vessels that supply the femoral head, thereby reducing the risk of avascular necrosis. Forceful reduction or open reduction attempts can tear those vessels and greatly increase the AVN risk, so they are not recommended. Observation isn’t adequate because the slip can progress and threaten blood flow, and intra-articular corticosteroid injections have no role in treating SCFE.