Complications After Modified Dunn Osteotomy for the Treatment of Adolescent Slipped Capital Femoral Epiphysis

Abstract

Level IV-therapeutic study.

Severe slipped capital femoral epiphysis: A French multicenter study of 186 cases performed by the SoFOP

“…Recent published studies have defined the idea of FAI and specified its risk of osteoarthritis, leading to renewed interest in reduction techniques [1,3,9,17,18,21]. Unfortunately, many studies have a small sample size, heterogeneous classification systems and very controversial results [1][2][3]9,17,18,[22][23][24][25][26][27].…”

Iatrogenic Hip Instability Is a Devastating Complication After the Modified Dunn Procedure for Severe Slipped Capital Femoral Epiphysis

“…To this point, this complication has received little attention [13]; however, after identifying a few sporadic instances of this complication, we performed a multicenter review, which identified 17 cases from eight institutions over a 7-year period. All these patients had severe proximal femoral deformity with a slip AP radiograph after sequential 1-mm distraction daily until the femoral head was at the level of the acetabulum.…”

“…They recommended this approach for both stable and unstable slips. Although the first case series published on 40 patients treated with the modified Dunn procedure [17] from two institutions reported only minor complications associated with this procedure including one patient with symptomatic heterotopic ossification and one patient with residual impingement who underwent an osteochondroplasty, subsequent studies have reported a higher risk of complications and more severe complications including avascular necrosis and fracture of internal fixation devices, resulting in slip progression, pain, or further revision surgical procedures [9,11,13,16].…”

“…Iatrogenic hip instability after the modified Dunn procedure has received little attention [13]. In fact, the original description of the procedure recommended resection of the ligamentum teres and loose closure of the hip capsule to avoid tensioning the retinacular vessels [17].…”

Arthroscopic Subcapital Realignment in Chronic and Stable Slipped Capital Femoral Epiphysis

“…The mean postoperative evolution for osteonecrosis was 21.4 weeks, and the patients who did not evolve with this complication presented significantly lower clinical pain scores, and higher postoperative satisfaction. 10 Upasani et al 11 presented the results of 43 patients treated using this technique: 60% of the cases were patients with unstable SCFE 9 ; 40% were considered acute; and 86% were classified as 3 Twenty-two complications were observed in 16 patients, with 15 revision surgeries due to AVN, failure of the fixation, and postoperative dislocation of the hip. Two patients needed indication for total hip arthroplasty.…”