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

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

doi:10.1007/s00264-018-3993-9

Cited by 24 publications

(28 citation statements)

References 26 publications

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“…An increasing number of articles have appeared in the literature on the treatment of SCFE with surgical dislocation2,5,43,55,61–66 demonstrating that this technique is effective. Novais et al67 compared children with severe stable SCFE treated with the modified Dunn procedure or in situ pinning in terms of proximal femoral radiographic deformity, Heyman and Herndon clinical outcome, complication rate, and number of reoperations performed after the initial procedure.…”

Section: Treatmentmentioning

confidence: 99%

<p>Slipped capital femoral epiphysis: current management strategies</p>

Aprato

Conti²,

Bertolo³

et al. 2019

ORR

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In orthopedic literature, there is little consensus regarding the best management of slipped capital femoral epiphysis (SCFE). Controversies and disparate trends derive from differences in clinical presentation, various classifications, and a variety of surgical procedures that have been described. Currently, there are no evidence-based recommendations. Surgical procedures vary, and they can be divided into fixation in situ, compensatory osteotomies, and direct corrections of the deformity at the head–neck junction. The first and second group of procedures have so far not gained optimal control over the risk of avascular necrosis or cannot achieve an anatomically aligned epiphysis with normal blood supply. On the other hand, the third technique can achieve this target and prevent residual deformity and the development of early hip arthritis, but it is not widely accepted, because of its surgical complexity. The purpose of this work is to present an overview of current knowledge and provide an orientation on clinical and surgical management of the patient suffering from SCFE.

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Section: Treatmentmentioning

confidence: 99%

<p>Slipped capital femoral epiphysis: current management strategies</p>

Aprato

Conti²,

Bertolo³

et al. 2019

ORR

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“…Subcapital osteotomies (modified Dunn) have been shown to provide good clinical and radiographic outcomes for treating severe and unstable slips when compared to in situ fixation. ( 8 …”

Section: Discussionmentioning

confidence: 99%

A Post-Treatment Retrospective Evaluation of Slipped Capital Femoral Epiphysis

et al. 2021

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Objective: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. Methods: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. Results: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. Conclusion: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients’ clinical and functional outcome. Level of Evidence II, Retrospective study.

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“…However, it is important to note that in the acute moderate to severe unstable SCFE, there is a baseline 20 to 50% risk of AVN with closed reduction followed by pinning [34,52]. A recent study comparing in situ pinning to modified Dunn in these patients showed a comparable AVN rate, but less femoral-sided deformity and better shortterm hip function in the patients undergoing modified Dunn [53]. Parsh also recently described an anterior open-reduction technique for the moderate to severe unstable SCFE that had excellent short-term clinical outcomes with low proportion of avascular necrosis and appropriate restoration of femoral anatomy [54].…”

Section: Treatmentsmentioning

confidence: 99%

“…While early studies on the outcome of the modified Dunn mostly came from Switzerland with excellent results [38••, 57], there have been multiple reports over the last few years on outcomes from other centers [53,58,59], They have mostly reported favorable outcomes and restoration of more appropriate femoral anatomy [58]. Because of these results from multiple centers, acute realignment of the moderate to severe acute SCFE with contemporary open-reduction techniques is becoming a viable treatment option to restore femoral anatomy where proper expertise is available.…”

Section: Treatmentsmentioning

confidence: 99%

“…However, controversy still surrounds about the indication for surgical treatment of stable SCFE with the modified Dunn procedure. Although a short-term studies have reported better outcomes compared to in situ pinning [53,58], and the swiss have reported excellent long-term results [38••], multiple studies have reported significant complications of the modified Dunn for SCFE [51,60,61]. With the Parsh technique and modified Dunn technique both demonstrating promising outcomes, multi-center prospective comparative outcomes studies are needed to elucidate the optimal approach to moderate to severe SCFE.…”

Section: Treatmentsmentioning

confidence: 99%

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Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis

Wylie

Novais

2019

Curr Rev Musculoskelet Med

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Purpose of Review To review slipped capital femoral epiphysis (SCFE), with a focus on new insights into its etiology and evolving methods of operative fixation. Recent Findings The epiphyseal tubercle and its size during adolescence are paramount to understanding the mechanism of SCFE. In chronic stable SCFE, the epiphysis rotates about the tubercle protecting the lateral epiphyseal vessels from disruption. In an acute unstable SCFE, the tubercle displaces, increasing the risk of osteonecrosis, also known as avascular necrosis (AVN). Intraoperative stability suggests that stable and unstable SCFE based on ambulation may be inaccurate. For stable SCFE, in situ pinning remains the most accepted treatment for mild slips with delayed symptomatic femoroacetabular impingement (FAI) management. Treatment of moderate to severe stable slips with realignment osteotomy leads to less femoral deformity and potentially better outcomes. However, it has a higher risk of complications, including AVN and chondrolysis. Summary Our knowledge of the etiology for SCFE is evolving. The optimal technique for operative treatment of moderate to severe SCFE is controversial and varies by center. Well-controlled studies of these patients are needed to understand the best treatment for this difficult problem. Furthermore, increasing the awareness about SCFE is paramount to allow for early recognition and treatment of deformity at its early stages and avoiding severe SCFE deformity which has been associated with worse long-term outcomes. Keywords Slipped capital femoral epiphysis . SCFE . Femoroacetabular impingement . Modified Dunn . Imhauser osteotomy . In situ pinning . Femoral osteoplasty This article is part of the Topical Collection on Pediatric Orthopedics

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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: 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.

Cited by 24 publications

References 26 publications

<p>Slipped capital femoral epiphysis: current management strategies</p>

<p>Slipped capital femoral epiphysis: current management strategies</p>

A Post-Treatment Retrospective Evaluation of Slipped Capital Femoral Epiphysis

Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis

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