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In situ fixation has been the gold standard for the treatment of slipped capital femoral epiphysis for some time. This technique has been popular despite obligate residual proximal femoral deformity due to the increased risk for catastrophic avascular necrosis of the femoral head with closed manipulation and historical open reduction techniques. As the body of evidence regarding long-term outcome has grown, it has become evident that early osteoarthritis is common after in situ or conservative treatment because of femoroacetabular impingement of the deformed femoral neck on the acetabular rim. New techniques have been developed that show promise in preventing the early onset of osteoarthritis while minimizing the risk of avascular necrosis with early realignment of the proximal femoral anatomy and elimination of femoroacetabular impingement.