The modified Dunn procedure for slipped capital femoral epiphysis does not reduce the length of the femoral neck

Abstract

Objective:The treatment of slipped capital femoral epiphysis (SCFE) is evolving, with the development of new surgical techniques. |We wanted to study if modified Dunn procedure restores the normal alignment of the proximal femur and the risk of avascular necrosis is increased.Methods:This is a single centre, retrospective study, comparing the outcomes of in situ pinning and modified Dunn procedure. Between 2001 and 2014, 7 children (7 hips) underwent the modified Dunn procedure and 10 children (10 hips) pinning in situ for stable and unstable SCFE. Mean age of the patients was 12.7 years with a median follow-up of 18 months.Results:The radiological parameters improved in the modified Dunn procedure group, while the length of the femoral neck didn’t change significantly (p=0.09). Postoperative clinical outcomes were slightly better in the modified Dunn procedure group (6 hips out of 7 had good and excellent results) compared to the pinning in situ group (8 good and excellent results out of 10 hips) (p=0.04). No avascular necrosis was found and there were no cases of chondrolysis.Conclusion:Radiographic parameters of the proximal femur assessed in our study improved in all hips that underwent modified Dunn procedure, without the creation of secondary deformities.

The Outcome of Modified Dunn's Procedure for Moderate and Severe Slipped Capital Femoral Epiphysis

“…Increasing recognition of FAI and chondro-labral damage even after mild SCFE [3,[14][15][16][17][18] has led to a reconsideration and change of the objectives of treatment of SCFE. The ideal treatment would involve stabilizing the physis to prevent further epiphyseal slippage and correcting the deformity at the subcapital level, at the same time, to prevent FAI and early arthrosis, and to normalize hip range of motion (ROM) [3,[5][6][7]13,15,19,20] .…”

“…Subcapital corrective osteotomies have the advantage of normal or near-normal restoration of the proximal femoral anatomy but are associated with potential risk of femoral head osteonecrosis [2][3][4][5]13,19,21,22] .…”

A literature review: physicaltherapy of the hip after septic arthritis

“…Unfortunately, medical literature provides little information about rehabilitation after septic osteoarthritis, as medical treatment is different depending on the time of diagnosis, patient age, and degree of joint damage. A diagnosis and medical, surgical and physiokinetotherapeutic treatment initiated at the right time means an excellent hip joint if it has normal ROM, and there is no limp and no pain (18,19). Due to the articular changes described above a special role is also the physical treatment of recovery and rehabilitation of patients to prevent joint redness, muscle atrophy, and the patient returns to a high level for daily living.…”

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

“…Novais et al [26] study 15 patients (100%) were severe. Dan Cosma et al [27] study 7 patients (100%) were severe ( . This reveals that our mean correction of slip angle is the highest due to inclusion of more severe cases (Table 4).…”

“…In Novais et al [26] study Heymann and Hernodon score was 9/15 had good and excellent results. In Dan Cosma et al [27] study Heymann and Hernodon score was 6/7 had good and excellent results ( Table 5).…”