FIGURE 121.14 Slipped capital femoral epiphysis of right hip Epiphysis is displaced medially on the frog view The degree of slippage is expressed with a grading system: grade I or preslip with possible widening of the physis but no displacement, grade II with displacement less than one-third of the width of the metaphysis, grade III with displacement of one-third to half of the metaphyseal width, and grade IV with displacement of greater than half the metaphyseal width Management/Indications for Discharge or Admission Children with SCFE who present with severe symptoms and/or acute onset should be admitted and promptly evaluated by an orthopedic surgeon Unstable SCFE is complicated by avascular necrosis of the femoral head in up to 20% of cases Patients with milder symptoms may be discharged on crutches, after timely orthopedic follow-up has been arranged Treatment of SCFE is primarily surgical Chondrolysis, the most common complication of SCFE, occurs in about 8% of patients Pain and persistent decreased range of motion after pinning are the usual presenting symptoms If the pins extend into the joint space, the risk of chondrolysis is increased Two-thirds of patients with chondrolysis have a progressive course Ankylosis may ensue, leading to long-term disability With a 15% risk of subsequent slippage of the contralateral hip, prophylactic pinning of the contralateral hip after unilateral SCFE is controversial Younger chronologic