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Loder et al. first pointed out the importance of physeal instability in predicting the risk of osteonecrosis after acute slipped capital femoral epiphysis, noting a 47% rate of osteonecrosis in their series1. Others have emphasized the importance of reduction of the slip, urgent treatment, and capsular decompression in decreasing the rate of osteonecrosis2,3. In 2009, Parsch et al. reported a 4.7% rate of osteonecrosis after open reduction of sixty-four hips with evidence of instability4.