A 10 year old girl presented to an orthopaedic colleague on Sept 22nd with a complaint of right hip pain. Xray (1) showed quite a subtle slip (SCFE = Slipped Capital Femoral Epiphysis). After some heartsearching about treating such a young patient he fixed the epiphysis in situ with a  single cannulated screw (2,3). She was doing well until October 14th. She got tied up on her crutches and fell down two steps. She has a sub-trochanteric fracture commencing at the screw hole. (4)
Is anyone familiar with this as a complication of treatment of SCFE?
I would assume that putting in more screws would make this more rather than less likely.
My plan of management is to do a Dynamic Hip Screw fixation. After reduction and prior to taking out the current screw I will put in 2 new K wires to try to prevent rotation as the old screw is backed out. Then I plan to pass a wire up the current cannulated screw, back it out and use the wire to guide the reamer for placing the lag screw. I don't plan to advance it any further than the current position of the screw. The rest of the operation should be straghtforward, attaching the lag screw to the side plate.
Would anyone treat this patient with closed reduction and traction? Any other internal fixation? Flexible IM rods?
Any comments about my proposed treatment?
I have told the family that this situation increases the risk of AVN - any comments on that?