Is the modified Dunn’s procedure superior to in situ fixation? A systematic review and meta-analysis of comparative studies for management of moderate and severe slipped capital femoral epiphysis

Cheok, Tim; Smith, Thomas; Berman, Morgan; Jennings, Matthew; Williams, Kanishka; Poonnoose, Pradeep Mathew; Rawat, Jaideep; Foster, Bruce K.

doi:10.1177/18632521221078864

Cited by 7 publications

(7 citation statements)

References 45 publications

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“…Although significant improvement can be observed in radiological outcomes, controversy still exists whether or not better outcomes can be obtained in stable and unstable slips, and additionally the number of long-term follow-up studies is very limited in this novel surgical technique. 4,23,24 Modified Dunn procedure was only taken into consideration in severe slips by the respondents in the present study, but a weak to moderate disagreement on the use of this procedure in all severe stable and unstable slip scenarios was observed. Therefore, respondents of the present study seem to be influenced from the limited current scientific evidence about the wider use of modified Dunn procedure in severe type of SCFE.…”

Section: Discussionmentioning

confidence: 64%

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

Karagüven

Demır

Yüksel

et al. 2023

Journal of Children's Orthopaedics

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Purpose: The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side. Methods: In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children’s orthopedics and in the treatment of hip disorders in children. Results: In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age. Conclusions: The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons’ treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances. Level of evidence: level V.

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Section: Discussionmentioning

confidence: 64%

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

Karagüven

Demır

Yüksel

et al. 2023

Journal of Children's Orthopaedics

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“…Numerous other studies have instead supported the safety of in situ fixation, with its clinical outcomes mirroring those of the Dunn procedure, but without the risk of complications and while avoiding the technical difficulties associated with the latter procedure [6,[24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Medium-long-term follow-up of slipped capital femoral epiphysis treated with in situ fixation and patient-acceptable symptom state evaluation

Priano,

De Pascali,

Caccavella

et al. 2024

Journal of Pediatric Orthopaedics B

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This study evaluates the Patient Acceptable Symptom State (PASS) in patients with slipped capital femoral epiphysis (SCFE) treated with in situ fixation, focusing on medium to long-term outcomes and quality of life. Its primary goal is to establish a subjective well-being cutoff, using subjective methods and the iHOT33 scale, for assessing patients in future studies. Additionally, it explores functionality differences between mild and moderate-severe SCFE, case series epidemiology and potential complications. A retrospective analysis of 63 patients (73 hips), treated for SCFE between 2000 and 2017 at our facility using in situ fixation, was conducted. These patients underwent clinical, anamnestic, and radiological assessments, with PASS determined based on iHOT33 questionnaire results and statistical analysis. The mean age at surgery was 12.95 years (±1.64, range 9–17), with an average follow-up of 11 years (±4.60, range 5–20). At follow-up, 87% of patients reported achieving PASS, with higher iHOT33 scores correlating to PASS. A cutoff of >68 on the iHOT33 scale showed strong predictive ability for assessing PASS (area under the curve 0.857, 88.89% sensitivity, 79.69% specificity). The findings indicate that 87% of patients achieved PASS at medium to long-term follow-up, with better clinical function than those who did not report PASS. The iHOT33 scale’s effectiveness in predicting PASS, especially with a cutoff of >68, suggests this method’s efficacy. Given these positive outcomes, including in moderate-severe cases treated with in situ fixation, this approach is considered a viable therapeutic option.

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“…Extensive studies of the vascular anatomy [6,7,10] have led Ganz to develop his technique of safe surgical hip dislocation [5] to treat problems not accessible by closed means. Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Since then, the indications for the appropriate treatment of SCFE and results are discussed controversially [7,[9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Romanyshyn,

Schchurovsky,

Ulrich Exner

2024

OTP

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Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

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Is the modified Dunn’s procedure superior to in situ fixation? A systematic review and meta-analysis of comparative studies for management of moderate and severe slipped capital femoral epiphysis

Cited by 7 publications

References 45 publications

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

Medium-long-term follow-up of slipped capital femoral epiphysis treated with in situ fixation and patient-acceptable symptom state evaluation

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

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