Treatment of unstable slipped capital femoral epiphysis with a modified Dunn’s procedure-a case report
Keywords:
Unstable, Slipped capital femoral epiphysis, Modified Dunn’s
Abstract
Slipped Capital Femoral Epiphysis (SCFE) is a relatively common disease of adolescents with drastic consequences in adult life if managed inappropriately. Several surgical techniques are described to reposition the proximal femoral epiphysis and are frequently associated with a high rate of femoral head osteonecrosis. The modified Dunn’s procedure has been shown to be safe and effective in treating unstable SCFE. The incidence of development of osteonecrosis is dramatically reduced by carefully preserving the posterior periosteal sleeve, thereby maintaining the vascularity to the head. We have performed this procedure in a 21-year-old male with bilateral, sequential, unstable SCFEs and achieved a satisfactory functional outcome at the end of one year.
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References
1. Kelsey JL, Keggi KJ, Southwick WO. The incidence and distribution of slipped capital femoral epiphysis in Connecticut and Southwestern United States. JBJS. 1970; 52(6):1203-1216.
2. Otani T, Futami T, Kita A, Kitano T, Saisu T, Satsuma S, et al. Treatment for unstable slipped capital femoral epiphysis: Current status and future challenge in Japan. J Orthop Sci. 2016; 21(6):847-851. doi: 10. 1016/j.jos.2016.07.024. Epub 2016 Sep 6.
3. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993; 75(8):1134-1140. doi:10.2106/ 00004623-199308000-00002
4. Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997; 17(5):648-54.doi:10.1097/00004694-199 709000-00013
5. Rattey T, Piehl F, Wright JG. Acute slipped capital femoral epiphysis. Review of outcomes and rates of avascular necrosis. J Bone Joint Surg Am. 1996;78 (3): 398-402. doi: 10.2106/ 00004623- 199603000-00011
6. Rhoad RC, Davidson RS, Heyman S, Dormans JP, Drummond DS. Pretreatment bone scan in SCFE: a predictor of ischemia and avascular necrosis. J Pediatr Orthop. 1999;19(2):164-168.doi:10.1097/00004694-199 903000-00006
7. Griffith MJ. Slipping of the capital femoral epiphysis. Ann R Coll Surg Engl. 1976;58(1):34-42.
8. Sankar WN, Vanderhave KL, Matheney T, Herrera-Soto JA, Karlen JW. The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective. J Bone Joint Surg Am. 2013;95(7):585-591. doi: 10.2106/JBJS.L.00203.
9. Slongo, T, Kakaty, D, Krause, F. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92(18): 2898-2908. doi: 10.2106/JBJS.I.01385
10. Schweitzer D, Klaber I, Zamora T, Amenábar PP, Botello E. Surgical dislocation of the hip without trochanteric osteotomy. J Orthop Surg (Hong Kong). 2017; 25 (1): 2309499016684414. doi: 10.1177/230949 9016684414.
11. Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg. British volume. 1964;46(4):621-629.
12. Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect. 2008;57:499-507.
13. Tannast M, Jost LM, Lerch TD, Schmaranzer F, Ziebarth K, Siebenrock KA. The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience. J Children's Orthopaed. 2017;11 (2): 138-146. doi: 10.1302/1863-2548-11-170046
14. Huber H, Dora C, Ramseier LE, Buck F, Dierauer S. Adolescent slipped capital femoral epiphysis treated by a modified Dunn osteotomy with surgical hip dislocation. J Bone Joint Surg Br. 2011; 93(6):833-838. doi: 10.1302/0301-620X.93B6.25849.
15. Persinger F, Davis RL 2nd, Samora WP, Klingele KE. Treatment of Unstable Slipped Capital Epiphysis Via the Modified Dunn Procedure. J Pediatr Orthop. 2018;38(1):3-8. doi: 10.1097/BPO.0000000000000737.
16. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29 (1): 1-8. doi: 10.1097/BPO.0b013e31818f0ea3.
17. Phillips SA, Griffiths WE, Clarke NM. The timing of reduction and stabilisation of the acute, unstable, slipped upper femoral epiphysis. J Bone Joint Surg Br. 2001; 83 (7): 1046-1049.doi: 10.1302/0301-620x. 83b7. 11640
2. Otani T, Futami T, Kita A, Kitano T, Saisu T, Satsuma S, et al. Treatment for unstable slipped capital femoral epiphysis: Current status and future challenge in Japan. J Orthop Sci. 2016; 21(6):847-851. doi: 10. 1016/j.jos.2016.07.024. Epub 2016 Sep 6.
3. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993; 75(8):1134-1140. doi:10.2106/ 00004623-199308000-00002
4. Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997; 17(5):648-54.doi:10.1097/00004694-199 709000-00013
5. Rattey T, Piehl F, Wright JG. Acute slipped capital femoral epiphysis. Review of outcomes and rates of avascular necrosis. J Bone Joint Surg Am. 1996;78 (3): 398-402. doi: 10.2106/ 00004623- 199603000-00011
6. Rhoad RC, Davidson RS, Heyman S, Dormans JP, Drummond DS. Pretreatment bone scan in SCFE: a predictor of ischemia and avascular necrosis. J Pediatr Orthop. 1999;19(2):164-168.doi:10.1097/00004694-199 903000-00006
7. Griffith MJ. Slipping of the capital femoral epiphysis. Ann R Coll Surg Engl. 1976;58(1):34-42.
8. Sankar WN, Vanderhave KL, Matheney T, Herrera-Soto JA, Karlen JW. The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective. J Bone Joint Surg Am. 2013;95(7):585-591. doi: 10.2106/JBJS.L.00203.
9. Slongo, T, Kakaty, D, Krause, F. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92(18): 2898-2908. doi: 10.2106/JBJS.I.01385
10. Schweitzer D, Klaber I, Zamora T, Amenábar PP, Botello E. Surgical dislocation of the hip without trochanteric osteotomy. J Orthop Surg (Hong Kong). 2017; 25 (1): 2309499016684414. doi: 10.1177/230949 9016684414.
11. Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg. British volume. 1964;46(4):621-629.
12. Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect. 2008;57:499-507.
13. Tannast M, Jost LM, Lerch TD, Schmaranzer F, Ziebarth K, Siebenrock KA. The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience. J Children's Orthopaed. 2017;11 (2): 138-146. doi: 10.1302/1863-2548-11-170046
14. Huber H, Dora C, Ramseier LE, Buck F, Dierauer S. Adolescent slipped capital femoral epiphysis treated by a modified Dunn osteotomy with surgical hip dislocation. J Bone Joint Surg Br. 2011; 93(6):833-838. doi: 10.1302/0301-620X.93B6.25849.
15. Persinger F, Davis RL 2nd, Samora WP, Klingele KE. Treatment of Unstable Slipped Capital Epiphysis Via the Modified Dunn Procedure. J Pediatr Orthop. 2018;38(1):3-8. doi: 10.1097/BPO.0000000000000737.
16. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29 (1): 1-8. doi: 10.1097/BPO.0b013e31818f0ea3.
17. Phillips SA, Griffiths WE, Clarke NM. The timing of reduction and stabilisation of the acute, unstable, slipped upper femoral epiphysis. J Bone Joint Surg Br. 2001; 83 (7): 1046-1049.doi: 10.1302/0301-620x. 83b7. 11640
CITATION
DOI: 10.17511/ijoso.2019.i04.01
Published: 2019-10-31
How to Cite
Kaul, R., Mohan Singh, C., & Thakur, K. (2019). Treatment of unstable slipped capital femoral epiphysis with a modified Dunn’s procedure-a case report. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(4), 234-238. https://doi.org/10.17511/ijoso.2019.i04.01
Section
Case Report
OAI - Open Archives Initiative
Therapoid
