Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership.

There is limited literature regarding the treatment of unstable slipped capital femoral epiphysis (SCFE). The Evidence Analysis Work Group (EAWG) initiated a questionnaire assessing management of unstable SCFE by the members of the Pediatric Orthopaedic Society of North America (POSNA). All members were surveyed by e-mail and fax. The survey was accessible through the POSNA web site. One third of the members responded. Seventy-three percent of members used the "stable/unstable" classification, while 27% used the "acute/chronic" terminology. Thirty-one percent of respondents felt that an unstable SCFE is an emergency, while 57% felt that treatment could be on an urgent (<8 hours) basis. Fifty-seven percent reported use of a single threaded screw for fixation for an unstable SCFE, and 40.3% recommended two threaded screws. There seems to be agreement on methods of patient evaluation, but discrepancies remain in classification and fixation methods. The EAWG recommends development of multicenter studies to evaluate the treatment of unstable SCFE.