SCFE: Which intervention is associated with an increased risk of avascular necrosis?

SCFE: Which intervention is associated with an increased risk of avascular necrosis?

• A. Non-weight bearing with crutches
• B. Early casting
• C. Physical therapy
• D. Open reduction with internal fixation

Answer: (D)

In slipped capital femoral epiphysis, protecting the blood supply to the femoral head is paramount because avascular necrosis arises when those vessels are compromised. Open reduction with internal fixation increases AVN risk because it requires surgical exposure and manipulation around the hip to realign the epiphysis, which can disrupt the retinacular vessels that provide the head’s blood supply. In contrast, stabilizing the slip with in situ pinning minimizes disruption to these vessels, preserving perfusion. Non-weight bearing or early casting helps manage the slip without adding vascular injury, and physical therapy alone doesn’t address stabilization or blood supply.

In slipped capital femoral epiphysis, protecting the blood supply to the femoral head is paramount because avascular necrosis arises when those vessels are compromised. Open reduction with internal fixation increases AVN risk because it requires surgical exposure and manipulation around the hip to realign the epiphysis, which can disrupt the retinacular vessels that provide the head’s blood supply. In contrast, stabilizing the slip with in situ pinning minimizes disruption to these vessels, preserving perfusion. Non-weight bearing or early casting helps manage the slip without adding vascular injury, and physical therapy alone doesn’t address stabilization or blood supply.