The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Open reduction of slipped capital femoral epiphysis, in January 2015.
The capital femoral epiphysis forms part of the ball-and-socket joint of the hip. In children and adolescents the ball and shaft of the femur are connected by a layer of soft cartilage, known as the growth plate, which allows for growth and hardens at adulthood. A slipped capital femoral epiphysis (SCFE) results in the displacement of the femoral head, usually posteriorly and inferiorly in relation to the femoral neck and within the confines of the acetabulum. This can cause knee and/or hip pain, limping and considerable deformity.
Treatment options depend on the severity of the slip. Treatment of mild-to-moderate slips usually involves percutaneous in situ fixation, with or without prophylactic pinning of the contralateral hip using cannulated screws or Kirschner wires. For more severe acute slips, treatment options include open fixation of the growth plate using a bone graft combined with early intertrochanteric osteotomy to allow a full range of hip movement, or closed reduction and in situ fixation with cannulated screws or Kirschner wires.
The OPCS-4 codes for open reduction of stable slipped capital femoral epiphysis are:
W68.1 Open reduction of injury to growth plate and internal fixation HFQ
Z76.8 Specified femur NEC
W08.5 Partial excision of bone NEC
Z76.2 Neck of femur
ICD-10 code M93.0 Slipped upper femoral epiphysis (nontraumatic)
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.