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Aims We describe surgical dislocation with capital realignment as an option for management of failed in-situ pinning in children with severe unstable slipped capital femoral physis. Patients and methods A retrospective data collection from our hospital hip database retrieved 7 patients with severe unstable slipped capital femoral physis who had failed in-situ pinning with severe deformity and grossly restricted movements. The failure of pinning in-situ was due to slip progression with inadequate screw purchase in four patients, stress