To test the traditional classification system of slipped capital femoral
epiphysis, we evaluated the presenting symptoms and radiographs of
fifty-four patients and reclassified the slipped epiphyses as unstable or
stable, rather than acute, chronic, or acute-on-chronic. Slips were
considered to be unstable when the patient had such severe pain that
weight-bearing was not possible even with crutches. Slips were considered
to be stable when the patient could bear weight, with or without crutches.
We reviewed the records on fifty-five hips in which the slip would have
been classified as acute because the duration of symptoms was less than
three weeks; thirty of these were unstable and twenty-five were stable. All
slips were treated with internal fixation. A reduction occurred in
twenty-six of the unstable hips and in two of the stable hips. Fourteen (47
per cent) of the thirty unstable hips and twenty-four (96 per cent) of the
twenty-five stable hips had a satisfactory result. Avascular necrosis
developed in fourteen (47 per cent) of the unstable hips and in none of the
stable hips. We were not able to demonstrate an association between early
reduction and the development of avascular necrosis.