Treatment of Slipped Capital Femoral Epiphysis with a Modified Dunn Procedure

Slongo, Theddy; Kakaty, Diganta; Krause, Fabian; Ziebarth, Kai

doi:10.2106/jbjs.i.01385

Cited by 161 publications

(173 citation statements)

References 36 publications

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“…An MRI study of 35 hips evaluated 12 years after treatment for mild or moderate SCFE also noted 24 hips had superior acetabular cartilage damage [28]. Some centers are aggressively treating even stable slips with early corrective osteotomies using a surgical hip dislocation approach with the aim of preventing future degenerative changes [37,43]. It is clear that some patients with a history of SCFE may eventually require THA, but it is unknown which hips become symptomatic over time [19].…”

Section: Discussionmentioning

confidence: 99%

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear. Questions/purposes We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning. Methods We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2-43 years).

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Section: Discussionmentioning

confidence: 99%

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The rates of AVN of the femoral head after unstable SCFE treatment vary from 5% to 47% [50,65,66,82]. Open reduction seems to play a role in reducing the rates of AVN in unstable SCFE [65,76,87]. The recently described surgical hip dislocation (SHD) approach [25] and development of a retinacular flap [26] that protects the blood supply to the femoral head has allowed treatment of unstable SCFE with lower rates of AVN [44,73,76,87].…”

Section: How Do We Get There?mentioning

confidence: 99%

“…Open reduction seems to play a role in reducing the rates of AVN in unstable SCFE [65,76,87]. The recently described surgical hip dislocation (SHD) approach [25] and development of a retinacular flap [26] that protects the blood supply to the femoral head has allowed treatment of unstable SCFE with lower rates of AVN [44,73,76,87]. The SHD approach offers the advantage of providing an anatomic reduction while preserving the soft tissue retinaculum containing the deep branch of the medial circumflex artery, the most important source of blood supply to the femoral head.…”

Section: How Do We Get There?mentioning

confidence: 99%

“…The SHD approach offers the advantage of providing an anatomic reduction while preserving the soft tissue retinaculum containing the deep branch of the medial circumflex artery, the most important source of blood supply to the femoral head. SHD and subcapital realignment have been reported to have a low complication rate in moderate to severe stable SCFE with wide open physes [76,87]. However, it is in the unstable SCFE that the SHD approach may theoretically decrease the complication of AVN [87].…”

Section: How Do We Get There?mentioning

confidence: 99%

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Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

Clinical Orthopaedics &Amp; Related Research

133

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Background Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term. Questions/Purposes We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment. Methods A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively. Where Are We Now? A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE. Where Do We Need to Go? Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes. How Do We Get There? Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.

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“…As the abductor is detached by trochanteric flip osteotomy rigid fixation of this flip fragment by screws restores immediate stability and allows for early mobilization of the patient. Direct inspection and preservation of physeal blood supply and inspection of intra-articular pathology which can be evaluated and treated at the time [24] .…”

Section: Introductionmentioning

confidence: 99%