Pretreatment bone scan in SCFE: A predictor of ischemia and avascular necrosis

Sixty-two consecutive patients with 73 slipped capital femoral epiphyses (S CFEs) underwent pretreatment planar technetium bone scan to identify the pr esence of ischemia of the femoral head. The relationship of pretreatment is chemia and the development of avascular necrosis (AVN) was evaluated after a minimum follow-up of 12 months. All patients were treated with spica cast ing or pinning across the physis. No Forceful manipulation was performed. N one of the 63 stable SCFEs demonstrated ischemia by bone scan, and none dev eloped AVN. Of the 10 unstable SCFEs, six demonstrated ischemia by bone sca n, and five of the six developed AVN. None of the four unstable SCFEs witho ut ischemia on bone scan developed AVN. Pretreatment bone scan is a sensiti ve predictor for development of AVN in unstable SCFEs and may provide a met hod for evaluating interventional treatments for AVN associated with SCFE.