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Scientific Articles   |    
Treatment of Slipped Capital Femoral Epiphysis with a Modified Dunn Procedure
Theddy Slongo, MD1; Diganta Kakaty, MD2; Fabian Krause, MD2; Kai Ziebarth, MD2
1 Division of Paediatric Trauma and Orthopaedics, Department of Paediatric Surgery, University Children's Hospital, Freiburgstrasse CH-3010 Bern, Switzerland. E-mail address: Theddy.slongo@insel.ch
2 Department of Orthopedic Surgery, University Hospital Bern, Freiburgstrasse, CH-3010 Bern, Switzerland. E-mail address for D. Kakaty: Diganta.Kakaty@insel.ch. E-mail address for F. Krause: Fabian.Krause@insel.ch. E-mail address for K. Ziebarth: Kai.Ziebarth@insel.ch
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Paediatric Surgery, University Children's Hospital, Bern, and the Department of Orthopedic Surgery, University Hospital Bern, Bern, Switzerland

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 15;92(18):2898-2908. doi: 10.2106/JBJS.I.01385
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Abstract

Background: 

Surgical procedures with use of traditional techniques to reposition the proximal femoral epiphysis in the treatment of slipped capital femoral epiphysis are associated with a high rate of femoral head osteonecrosis. Therefore, most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal part of the femur. This residual deformity can lead to secondary osteoarthritis resulting from femoroacetabular cam impingement.

Methods: 

We retrospectively assessed the cases of twenty-three patients with slipped capital femoral epiphysis after surgical correction with a modified Dunn procedure, an approach that included surgical hip dislocation. The study reviewed the clinical status and radiographs made at the time of surgery, as well as the intraoperative findings. At a minimum follow-up of twenty-four months after surgery, the motion of the treated hip was compared with the motion of the contralateral hip, and the radiographic findings related to the anatomy of the femoral head-neck junction, as well as signs of early osteoarthritis or osteonecrosis, were evaluated.

Results: 

Twenty-one patients had excellent clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients who developed severe osteoarthritis and osteonecrosis had a poor outcome. The mean slip angle of the femoral head of 47.6° preoperatively was corrected to a normal value of 4.6° (p < 0.0001). The mean flexion and internal rotation postoperatively were 107.3° and 37.8°, respectively. The mean range of motion of the treated hips was not significantly different (p > 0.05) from that of the normal, contralateral hips. Of the eight hips that were considered unstable in the intraoperative clinical assessment, six had been considered stable preoperatively.

Conclusions: 

The treatment of slipped capital femoral epiphysis with the modified Dunn procedure allows the restoration of more normal proximal femoral anatomy by complete correction of the slip angle, such that probability of secondary osteoarthritis and femoroacetabular cam impingement may be minimized. The complication rate from this procedure in our series was low, even in the treatment of unstable slipped capital femoral epiphysis, compared with alternative procedures described in the literature for fixation of slipped capital femoral epiphysis.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    John D. King, MD
    Posted on February 11, 2011
    Letter the the Editor
    Pediatric Orthopaedic Spine & Trauma Surgeons, Valencia, California

    To the Editor:

    This letter is regarding the article by Slongo et al. entitled, "Treatment of Slipped Capital Femoral Epiphysis with a Modified Dunn Procedure" (2010;92:2898-908). I read the article and all that surgery is unnecessary. Any severely displaced fracture will go back into place anatomically after they have been put in skeletal traction. That is, traction to the distal femur for several days in a position of abduction, flexion, and internal rotation, then it can be pinned anatomically. You are wasting your time doing all that surgery, it is simply unnecessary. Of the cases that we have done we have no incidence of avascular necrosis and they have had 2 out of 24.

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