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Letters to the Editor to:

Scientific Articles:
Keti P. Tokmakova, Robert P. Stanton, and Dan E. Mason
Factors Influencing the Development of Osteonecrosis in Patients Treated for Slipped Capital Femoral Epiphysis
J Bone Joint Surg Am 2003; 85: 798-801 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Physeal Stability and the Loder Classification of SCFE
Roderick D D Duncan   (18 June 2003)

Physeal Stability and the Loder Classification of SCFE 18 June 2003
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Roderick D D Duncan,
Paediatric Orthopaedic Surgeon
Royal Hospital for Sick Children Glasgow

Send letter to journal:
Re: Physeal Stability and the Loder Classification of SCFE

gcl243{at}clinmed.gla.ac.uk Roderick D D Duncan

Sir, The paper by Tokmakova et al (1) is a very valuable contribution to our understanding of slipped capital femoral epiphysis. Two things are clear however - firstly that Loder stable and unstable slips behave very differently. The second thing is that actual stability of the physis is less important than the clinical presentation. Even in Dr Loders original description (2), which remains a landmark paper, the evidence that the clinical presentation relates to physeal stability is far from conclusive. This has been confirmed by others. The terms stable and unstable have become widely accepted in Paediatric Orthopaedic circles, but I suggest these terms are inappropriate. Perhaps Loder Positive SCFE (severe pain that walking is not possible even with crutches) and Loder Negative SCFE (able to bear walk or weight bearstill possible with or without crutches) would be less misleading?

References: 1. Keti P. et al Factors Influencing the Development of Osteonecrosis in Patients Treated for Slipped Capital Femoral Epiphysis J Bone Joint Surg Am 2003; 85: 798-801 2. Loder et al Acute slipped capital epiphysis: the importance of physeal stability J Bone Joint Surg Am. 1993: 75:1134-1140