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International Orthopaedics

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01-03-2019 | Original Paper

The modified Dunn procedure provides superior short-term outcomes in the treatment of the unstable slipped capital femoral epiphysis as compared to the inadvertent closed reduction and percutaneous pinning: a comparative clinical study

Authors: Eduardo N. Novais, Daniel A. Maranho, Travis Heare, Ernest Sink, Patrick M. Carry, Courtney O’Donnel

Published in: International Orthopaedics | Issue 3/2019

Abstract

Purpose

The aim of this study was to compare clinical outcomes and radiographic correction after modified Dunn procedure versus inadvertent closed reduction and percutaneous pinning for the treatment of unstable slipped capital femoral epiphysis (SCFE).

Methods

We evaluated 45 patients with unstable SCFE treated using the modified Dunn procedure (n = 27) or percutaneous pinning (n = 18) during a minimum follow-up of one year. Clinical outcomes were assessed using the Heyman and Herndon scores. The Southwick angle, alpha angle, and femoral head-neck offset were used to assess radiographic correction. The occurrence of complications and unplanned re-operations were recorded.

Results

At latest follow-up, 67% (18/27) in the modified Dunn procedure group and 28% (5/18) in the in situ pinning group had good or excellent Heyman and Herndon outcomes (p = 0.016). The morphology of the femoral head and neck was improved in the modified Dunn procedure group compared to percutaneous pinning (Southwick angle, alpha angles; femoral head-neck offset; p < 0.001). The proportion of osteonecrosis (26 vs. 28%; p > 0.999) and unplanned re-operations (26 vs. 33%; p = 0.894) was similar in both groups.

Conclusion

Compared to inadvertent reduction and percutaneous pinning, the modified Dunn procedure provided better clinical and radiographic outcomes with similar proportion of osteonecrosis and unplanned re-operations following an unstable SCFE.

Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD (1993) Acute slipped capital femoral epiphysis: the importance of physeal stability. The Journal of Bone and Joint Surgery American 75:1134–1140CrossRef

Aronsson DD, Loder RT (1996) Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop Relat Res:99–110

Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ (2009) Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 467:704–716. https://doi.org/10.1007/s11999-008-0687-4 CrossRefPubMedPubMedCentral

Madan SS, Cooper AP, Davies AG (2013) The treament of severe slipped capital femoral epiphysis via the Ganz surgical dislocation approach—a prospective study. The Bone and Joint Journal 95-B:424–429CrossRef

Sankar WN, Vanderhave KL, Matheney T, Herrera-Soto JA, Karlen JW (2013) The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective. The Journal of Bone and Joint Surgery American 95:585–591. https://doi.org/10.2106/jbjs.l.00203 CrossRef

Souder CD, Bomar JD, Wenger DR (2014) The role of capital realignment versus in situ stabilization for the treatment of slipped capital femoral epiphysis. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000000193

Upasani VV, Matheney TH, Spencer SA, Kim YJ, Millis MB, Kasser JR (2014) Complications after modified Dunn osteotomy for the treatment of adolescent slipped capital femoral epiphysis. J Pediatr Orthop 34:661–667. https://doi.org/10.1097/BPO.0000000000000161 CrossRefPubMed

Alves C, Steele M, Narayanan U, Howard A, Alman B, Wright JG (2012) Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study. J Child Orthop 6:277–283. https://doi.org/10.1007/s11832-012-0423-1 CrossRefPubMedPubMedCentral

Arora S, Dutt V, Palocaren T, Madhuri V (2013) Slipped upper femoral epiphysis: outcome after in situ fixation and capital realignment technique. Indian Journal of Orthopaedics 47:264–271. https://doi.org/10.4103/0019-5413.111492 CrossRefPubMedPubMedCentral

10.

Heyman CH, Herndon CH (1954) Epiphy seodesis for early slipping of the upper femoral epiphysis. J Bone Joint Surg Am 36-A:539–555CrossRef

11.

Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery American 49:807–835CrossRef

12.

Notzli HP, Siebenrock KA, Hempfing A, Ramseier LE, Ganz R (2002) Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. The Journal of Bone and Joint Surgery British 84:300–304CrossRef

13.

Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. The Journal of Bone and Joint Surgery British 77:34–41CrossRef

14.

Novais EN, Sink EL, Kestel LA, Carry PM, Abdo JC, Heare TC (2016) Is assessment of femoral head perfusion during modified Dunn for unstable slipped capital femoral epiphysis an accurate indicator of osteonecrosis? Clin Orthop Relat Res 474:1837–1844. https://doi.org/10.1007/s11999-016-4819-y CrossRefPubMedPubMedCentral

15.

Thawrani DP, Feldman DS, Sala DA (2015) Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000000496

16.

Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57:499–507PubMed

17.

Slongo T, Kakaty D, Krause F, Ziebarth K (2010) Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am 92:2898–2908. https://doi.org/10.2106/JBJS.I.01385 CrossRefPubMed

18.

Jones JR, Paterson DC, Hillier TM, Foster BK (1990) Remodelling after pinning for slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery British 72:568–573CrossRef

19.

Rab GT (1999) The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 19:419–424CrossRef

20.

Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71:370–375. https://doi.org/10.1080/000164700317393367 CrossRefPubMed

21.

Ziebarth K, Domayer S, Slongo T, Kim YJ, Ganz R (2012) Clinical stability of slipped capital femoral epiphysis does not correlate with intraoperative stability. Clin Orthop Relat Res 470:2274–2279. https://doi.org/10.1007/s11999-012-2339-y CrossRefPubMedPubMedCentral

22.

Lykissas MG, McCarthy JJ (2013) Should all unstable slipped capital femoral epiphysis be treated open? J Pediatr Orthop 33(Suppl 1):S92–S98. https://doi.org/10.1097/BPO.0b013e318274f716 CrossRefPubMed

23.

Palocaren T, Holmes L, Rogers K, Kumar SJ (2010) Outcome of in situ pinning in patients with unstable slipped capital femoral epiphysis: assessment of risk factors associated with avascular necrosis. J Pediatr Orthop 30:31–36. https://doi.org/10.1097/BPO.0b013e3181c537b0 CrossRefPubMed

24.

Seller K, Wild A, Westhoff B, Raab P, Krauspe R (2006) Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis. Int Orthop 30:342–347. https://doi.org/10.1007/s00264-006-0110-2 CrossRefPubMedPubMedCentral

25.

Parsch K, Weller S, Parsch D (2009) Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop 29:1–8. https://doi.org/10.1097/BPO.0b013e31818f0ea3 CrossRefPubMed

26.

Schrader T, Jones CR, Kaufman AM, Herzog MM (2016) Intraoperative monitoring of epiphyseal perfusion in slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery American 98:1030–1040. https://doi.org/10.2106/JBJS.15.01002 CrossRef

Title: The modified Dunn procedure provides superior short-term outcomes in the treatment of the unstable slipped capital femoral epiphysis as compared to the inadvertent closed reduction and percutaneous pinning: a comparative clinical study
Authors: Eduardo N. Novais
Daniel A. Maranho
Travis Heare
Ernest Sink
Patrick M. Carry
Courtney O’Donnel
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 3/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3993-9

At a glance: The STEP trials

Springer Medicine

The modified Dunn procedure provides superior short-term outcomes in the treatment of the unstable slipped capital femoral epiphysis as compared to the inadvertent closed reduction and percutaneous pinning: a comparative clinical study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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