Two studies compared outcomes of observation vs prophylactic in situ pinning after an initial SCFE.8,9 The first showed benefit in the pinning of the contralateral hip,8 while the second study showed optimal benefit in the observation group, except among higher risk patients or patients in whom follow-up was problematic.9
Because of the heightened likelihood of future contralateral SCFE and the significant morbidity associated with delayed treatment, prophylactic pinning of the contralateral hip should be considered in patients after an initial SCFE—especially in certain high-risk groups8,9(strength of recommendation: B). Future large, randomized trials with patient-oriented outcomes would be useful.
Clearly, final treatment decisions will involve patient preferences and patient-specific factors including age and comorbidities.
Back on track after 2 surgeries
My patient did well after recovering from her second surgery (FIGURE 2B). I encouraged her to lose weight by eating well and exercising regularly.
The patient followed standard postoperative instructions of nonweight bearing for 6 weeks after each surgery. She returned to her prior functional status and continues to do well.
CORRESPONDENCE: Mark A. McElhannon, MD, Atlanta Medical Center Family Practice Residency, 1000 Corporate Center Drive, Suite 200, Morrow, GA 30260; andymc12342003@yahoo.com