Necrose avascular pós-cirurgia de Dunn modificada no tratamento do escorregamento da epífise proximal do fêmur*

Valenza, Weverley Rubele; Soni, Jamil Faissal; Przysiada, Laís; Faggion, Heloísa

doi:10.1055/s-0042-1744499

Cited by 3 publications

(7 citation statements)

References 33 publications

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“…The prevalence of AVN ranges from 6.5% to 53% in unstable cases in multiple studies found in the literature. 2 5 6 10 16 23 24 34 Our sample presented a rate of AVN of 26% (8 hips), which is comparable to a previously published multicentric American study published in 2013, 11 which only evaluated unstable slips. In a Brazilian SCFE cohort recently published by Valenza et al, 34 an overall AVN rate of 25% was found among stable and unstable slips, which is also compatible with our sample, even though we only studied unstable cases.…”

Section: Discussionsupporting

confidence: 84%

“… 2 5 6 10 16 23 24 34 Our sample presented a rate of AVN of 26% (8 hips), which is comparable to a previously published multicentric American study published in 2013, 11 which only evaluated unstable slips. In a Brazilian SCFE cohort recently published by Valenza et al, 34 an overall AVN rate of 25% was found among stable and unstable slips, which is also compatible with our sample, even though we only studied unstable cases. It is important to mention that different techniques for capital realignment are used internationally to treat SCFE.…”

Section: Discussionsupporting

confidence: 84%

“…Segundo a literatura, 2 5 6 10 16 23 24 34 a prevalência de NAV nos casos instáveis varia de 6,5% a 53%. Em nossa amostra, a frequência de NAV foi de 26% (8 quadris), comparável àquela observada em um estudo multicêntrico americano publicado em 2013, 11 que avaliou apenas escorregamentos instáveis.…”

Section: Discussionunclassified

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Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Vallim

Cruz

Silva

et al. 2023

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar a segurança e a reprodutibilidade da cirurgia para escorregamento da epífise femoral proximal (EEPF) com instabilidade por meio da técnica de Dunn modificada em uma coorte unicêntrica no Brasil. Métodos Analisamos de forma retrospectiva uma coorte de pacientes submetidos a esse procedimento por um único cirurgião especialista em preservação do quadril. Avaliamos os dados demográficos e os ângulos radiográficos quanto ao risco relativo (RR) de necrose avascular (NAV) por meio do modelo de regressão log-binomial com efeitos simples e aleatórios. Resultados Entre os 30 pacientes (30 quadris) com idade média de 11,79 anos no momento da cirurgia, havia 17 meninos e 18 quadris esquerdos. O procedimento ocorreu em média 11,5 dias após o escorregamento. O tempo médio de acompanhamento foi de 38 meses. O ângulo de Southwick pré-operatório foi, em média, de 60,69° contra 4,52° após o procedimento (p < 0,001). O maior ângulo de escorregamento pré-operatório foi associado ao desenvolvimento de NAV (RR: 1,05; intervalo de confiança de 95% [IC95%]: 1,02–1,07; p < 0,01). A frequência geral de NAV foi de 26,7%. De acordo com a Escala de Quadril de Harris (Harris Hip Score), a função foi boa ou excelente em 86% dos quadris sem complicações, e ruim em 87,5% dos casos com NAV. Não houve relação estatística entre sangramento epifisário e desenvolvimento de NAV (p = 0,82). Conclusão A técnica de Dunn modificada restaura o alinhamento femoral e a função articular após o EEPF com instabilidade na ausência de complicações. Além disso, mostrou-se passível de reprodução em nossa população, com frequência de necrose da cabeça femoral de 26%.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

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Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Vallim

Cruz

Silva

et al. 2023

Rev Bras Ortop (Sao Paulo)

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“…After Aprato's study, several authors have reported eight additional cases of HI [17,40,41,44] with a prevalence of about 6.6%. However, the etiology of HI was recognized in only two of the eight reported cases: one case was caused by a loose body into the hip joint [41] and the other by the interposition of the in-folded capsule between the femoral head and the acetabular walls [43].…”

Section: Discussionmentioning

confidence: 99%

“…The gradual spread of MDP throughout the world during the last 16 years has changed the approach to SCFE treatment, prompting more and more surgeons to adopt MDP, attracted by the good result obtained with this technique. However, most authors have indicated MDP in moderate to severe SCFE [16,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], while others have extended the indication to mild SCFE as well [15,[45][46][47]. This new trend has also influenced the indication for "in situ" pinning (ISP) that represents a milestone in SCFE treatment.…”

Section: Discussionmentioning

confidence: 99%

Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications

et al. 2023

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Background. The modified Dunn procedure (MDP) has become popular during the last 16 years to treat severely displaced slipped capital femoral epiphysis (SCFE) while “in situ” pinning (ISP) has remained valid to treat mild to moderate SCFE, although the indication limit of the Southwick angle (SA) has not yet been established for either procedure. In this context, we reviewed two cohorts of patients with SCFE, one treated by ISP and the other by MDP. We also tried to better elucidate the etiopathogenesis of hip instability, a severe complication of MDP. Methods. Fifty-one consecutive patients with 62 hips affected by SCFE were treated by us from 2015 to 2019: 48 hips with a SA ≤ 40° had ISP while 14, with the SA > 40°, had MDP. The latter also had a CT scan to better investigate the SCFE morphology. Results were assessed using the Harris Hip Score. Results. The mean length of follow up of the two cohorts was 5.4 years (range: 3 to 8 years). Of the 35 hips operated by ISP with a full follow-up evaluation, 30 had an excellent or good result, 3, fair, and 2, poor. Of the 14 hips that underwent MDP, 11 had an excellent or good result, 1, fair, and 2, poor. A CT scan showed femoro-acetabular incongruency in two unstable hips following MDP. Conclusions. We performed ISP in chronic SCFE with the SA ≤ 40° and MDP in acute and chronic SCFE with the SA > 40°, with satisfactory results. In both acute-on-chronic and chronic long-lasting SCFE with severe displacement, planned for MDP, a CT scan should be carried out to evaluate possible femoro-acetabular incongruency that may cause hip instability.

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The Medium- to Long-Term Results of Vascular-Sparing Subcapital Osteotomy (VASSCO) for Pediatric Patients with Chronic Slipped Capital Femoral Epiphysis

Faldini,

Di Martino,

Brunello

et al. 2024

JCM

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Background: In patients affected by chronic slipped capital femoral epiphysis (C-SCFE), the performance of a subcapital osteotomy is an effective procedure to correct the deformity at the proximal femur. However, the rate of postoperative complications is very high, with iatrogenic avascular necrosis of the femoral head (AVN) being the most bothersome. To overcome the risk of AVN, the modified Dunn procedure according to Ganz and, more recently, the Vascular Sparing Subcapital Osteotomy (VASSCO) technique have been proposed; however, only short-term follow-up studies are available on the latter technique being used. The aim of this study is therefore to show our mid-term clinical and radiological results with the VASSCO technique. Materials and Methods: A total of 26 patients underwent VASSCO for moderate or severe stable C-SCFE between 2012 and April 2016 with an average 10-year follow-up (range 8–12 years). The outcomes was evaluated using the HHS and pre- and postoperative ROM. The radiological outcomes and complications were collected. Results: No major intraoperative complications occurred; three patients reported postoperative transient apraxia of the lateral femoral cutaneous nerve, which completely recovered in six months. All the radiological outcomes showed substantial improvement postoperatively. One case patient developed AVN of the femoral head and required a total hip arthroplasty after 12 years. Conclusions: The current data suggest that VASSCO osteotomy is a reliable technique with very good clinical results at mid-term follow-up; it could be considered a valuable alternative to using more complex techniques to restore the proximal femoral anatomy in moderate to severe C-SCFE.

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Necrose avascular pós-cirurgia de Dunn modificada no tratamento do escorregamento da epífise proximal do fêmur*

Cited by 3 publications

References 33 publications

Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications

The Medium- to Long-Term Results of Vascular-Sparing Subcapital Osteotomy (VASSCO) for Pediatric Patients with Chronic Slipped Capital Femoral Epiphysis

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