Slipped capital femoral epiphysis: rationale for the technique of percutaneous in situ fixation.

In pinning a slipped capital femoral epiphysis (SCFE), the position of the pin within the center of the femoral head is important for two reasons. The pin may disrupt the lateral epiphyseal artery and cause avascular necrosis (AVN), or pin penetration in certain locations may go unrecognized on radiographs. To place the pin accurately, the surgeon must be aware of where the femoral head lies in relation to the femoral neck and the shaft. Radiographs of models and of patients in various positions support the view that the femoral head in most cases of chronic SCFE rotates around the axis of the femoral neck and does not slip inferiorly. Therefore, the starting point for an in situ fixation device is the anterior femoral neck, the exact location depending on the amount of slipping.