Outcome of slipped capital femoral epiphysis in renal osteodystrophy

The cases of renal osteodystrophy-associated slipped capital femoral epiphysis in 11 consecutive patients were reviewed. Nine patients had bilateral involvement, totaling 20 hips. The mean age at presentation was 10.6 years. Slip location was physeal in 13 and metaphyseal in seven hips. All patients had prompt medical treatment of their bone disease, and nine patients underwent surgical stabilization. Fixation consisted of multiple custom-machined Steinmann pins that were smoothed distally but threaded proximally, allowing continned proximal femoral growth. The mean radiographic and clinical follow-up was 5.7 years and 9.1 years, respectively. Slips stabilized in 14 of 16 operated hips (88%), whereas one patient with inadequate renal disease control had slip progression requiring subsequent subtotal parathyroidectomy and repeat fixation. Combined medical management and surgery with custom-machined pins prevented slip progression while allowing continued physeal growth.