Treatment of Slipped Capital Femoral Epiphysis with a Modified Dunn Procedure

Slongo, Theddy; Kakaty, Diganta; Krause, Fabian; Ziebarth, Kai
December 2010
Journal of Bone & Joint Surgery, American Volume;12/15/2010, Vol. 92-A Issue 18, p2898
Academic Journal
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.


Related Articles

  • Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis. Zaltz, Ira; Baca, Geneva; Clohisy, John // Clinical Orthopaedics & Related Research;Jul2013, Vol. 471 Issue 7, p2192 

    Background: The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious...

  • Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE. Novais, Eduardo; Hill, Mary; Carry, Patrick; Heare, Travis; Sink, Ernest // Clinical Orthopaedics & Related Research;Jun2015, Vol. 473 Issue 6, p2108 

    Background: In situ pinning is the conventional treatment for a stable slipped capital femoral epiphysis (SCFE). However, with a severe stable SCFE the residual deformity may lead to femoroacetabular impingement and articular cartilage damage. A modified Dunn subcapital realignment procedure has...

  • Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Johannson, Henning R.; Zywiel, Michael G.; Marker, David R.; Jones, Lynne C.; McGrath, Mike S.; Mont, Michael A. // International Orthopaedics;Apr2011, Vol. 35 Issue 4, p465 

    The primary goals of this critical literature review were to determine whether revision rates of primary total hip arthroplasty in patients with osteonecrosis differ based on the underlying associated risk factors and diagnoses, whether the outcomes of this procedure have improved over the past...

  • The Diagnosis and Management of Spontaneous and Post-Arthroscopy Osteonecrosis of the Knee. Strauss, Eric J.; Kang, Richard; Bush-Joseph, Charles; Bach, Bernard R. // Bulletin of the NYU Hospital for Joint Diseases;2011, Vol. 69 Issue 4, p320 

    Spontaneous osteonecrosis of the knee (SPONK) and osteonecrosis in the postoperative knee (ONPK) are two clinical entities that have the potential to cause significant morbidity in affected patients, In addition to the knowledge of the patient population at risk and the classic presentation and...

  • What Are the Risks of Prophylactic Pinning to Prevent Contralateral Slipped Capital Femoral Epiphysis? Sankar, Wudbhav; Novais, Eduardo; Lee, Christopher; Al-Omari, Ali; Choi, Paul; Shore, Benjamin // Clinical Orthopaedics & Related Research;Jul2013, Vol. 471 Issue 7, p2118 

    Background: Two decision analyses on managing the contralateral, unaffected hip after unilateral slipped capital femoral epiphysis (SCFE) have failed to yield consistent recommendations. Missing from both, however, are sufficient data on the risks associated with prophylactic pinning using...

  • A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis. Nasreddine, Adam; Heyworth, Benton; Zurakowski, David; Kocher, Mininder // Clinical Orthopaedics & Related Research;Jul2013, Vol. 471 Issue 7, p2137 

    Background: Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter...

  • Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis. Thompson, George; Lea, Ethan; Chin, Kenneth; Liu, Raymond; Son-Hing, Jochen; Gilmore, Allison // Clinical Orthopaedics & Related Research;Jul2013, Vol. 471 Issue 7, p2199 

    Background: Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a...

  • The Modified Dunn Procedure for Unstable Slipped Capital Femoral Epiphysis. Sankar, Wudbhav N.; Vanderhave, Kelly L.; Matheney, Travis; Herrera-Soto, José A.; Karlen, Judson W. // Journal of Bone & Joint Surgery, American Volume;4/3/2013, Vol. 95-A Issue 7, p585 

    Background: The modified Dunn procedure has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis (SCFE), but limited data exist regarding its safety and efficacy. The purpose of this study was to present results and complications following this procedure in a...

  • Osteonecrosis After Proximal Femoral Osteotomy in Spastic Encephalopathy. Stasikelis, Peter J.; Allen Jr., Benjamin L. // Orthopedics;Mar2004, Vol. 27 Issue 3, p330 

    Presents cases of osteonecrosis in patients who have undergone proximal femoral osteotomy. Effectiveness of proximal femoral osteotomy; Complications resulting from proximal femoral osteotomy performed in children.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics