The Modified Dunn Procedure for Unstable Slipped Capital Femoral Epiphysis

Sankar, Wudbhav N.; Vanderhave, Kelly L.; Matheney, Travis; Herrera-Soto, José A.; Karlen, Judson

doi:10.2106/jbjs.l.00203

Cited by 148 publications

(163 citation statements)

References 25 publications

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“…Finally, the followup on this series of patients is relatively short, and because the series is small, it would not take very many events in the test (+) group or the test (À) group for our conclusions to change, which reflects low statistical power. However, our experience as well as that of other investigators [15,16,24] is that the development of osteonecrosis after SCFE occurs within the first 12 months of treatment. In this series, all patients who were diagnosed with osteonecrosis developed it within a year of treatment.…”

Section: Discussionsupporting

confidence: 77%

“…Thus, the overall proportion of patients who developed osteonecrosis may be higher than the expected proportion reported by the originators of the technique [13,14,29]. However, all surgeons were experienced in the surgical dislocation approach and the proportion of osteonecrosis in this series compares well to other recent studies [24,25]. We believe that by including multiple surgeons with relevant expertise, we improved the external validity of our study.…”

Section: Discussionmentioning

confidence: 48%

“…There has been a recent increase in interest of the modified Dunn procedure for the treatment of SCFE [24]. The increased attention is most likely related to the fact that osteonecrosis of the femoral head was not reported in the first descriptive studies [13,14,29].…”

Section: Discussionmentioning

confidence: 99%

“…Two patients who were lost to followup before 1 year were excluded from the study, leaving 27 patients followed for a minimum of 1 year. Because osteonecrosis after unstable SCFE typically develops within the first year of surgery [15,16,24], we set minimum followup of this study to 1 year. The median duration of followup was 2.5 years (range, 1-8 years).…”

Section: Methodsmentioning

confidence: 99%

“…One of the benefits of the subcapital realignment through the surgical dislocation approach (modified Dunn procedure) is visualization and protection of the vascular retinaculum and direct assessment of perfusion of the femoral head during surgery. Femoral head perfusion may be assessed by evaluating bleeding after creating a 2-mm drill hole [9,24,30,31], by laser-Doppler flowmetry [9,30], and/or by intracranial pressure probe monitoring [24]. Assessment of perfusion during surgery may allow for adjustments of positioning the femoral head if blood flow decreases after the femoral head is reduced.…”

Section: Introductionmentioning

confidence: 99%

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Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

Novais

Sink

Kestel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. Questions/purposes We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Methods Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Children's Hospital Colorado, Aurora, CO, USA. osteonecrosis. Mea...

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Section: Discussionsupporting

confidence: 77%