The Role of Capital Realignment Versus In Situ Stabilization for the Treatment of Slipped Capital Femoral Epiphysis

Souder, Christopher; Bomar, James D.; Wenger, Dennis R.

doi:10.1097/bpo.0000000000000193

Cited by 68 publications

(73 citation statements)

References 41 publications

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“…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: 46%

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: Discussionmentioning

confidence: 46%

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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“…Encouraging results with complete restoration of proximal femoral anatomy and low rates of osteonecrosis for stable SCFE have been reported [17,24,26,33,39]. Nevertheless, to our knowledge, only one study has evaluated the modified Dunn procedure versus in situ pinning for treatment of stable SCFE [34]. Souder et al reported a 20% rate of osteonecrosis after the modified Dunn procedure for stable SCFE, however the severity of their cases was not reported [34].…”

Section: Introductionmentioning

confidence: 91%

“…Nevertheless, to our knowledge, only one study has evaluated the modified Dunn procedure versus in situ pinning for treatment of stable SCFE [34]. Souder et al reported a 20% rate of osteonecrosis after the modified Dunn procedure for stable SCFE, however the severity of their cases was not reported [34].…”

Section: Introductionmentioning

confidence: 99%

Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE

Novais

Hill

Carry

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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 been developed to allow for correction at the level of the deformity while preserving the blood supply to the femoral head. Questions/purposes We compared children with severe stable SCFE treated with the modified Dunn procedure or in situ pinning in terms of (1) proximal femoral radiographic deformity; (2) Heyman and Herndon clinical outcome; (3) complication rate; and (4) number of reoperations performed after the initial procedure. Methods In this nonmatched retrospective study, 15 patients treated with the modified Dunn procedure (between 2007 and 2012) and 15 treated with in situ pinning (between 2001 and 2009) for severe but stable SCFE were followed for a mean of 2.5 years (range, 1-6 years). During the period in question, the decision regarding which procedure to use was based on the on-call surgeon's discretion; six surgeons performed in situ pinning and three surgeons performed the modified Dunn procedure. A total of 15 other patients were treated for the same diagnosis during the study period but were lost to followup before 1 year; of those, 12 were in the in situ pinning group. Radiographs were reviewed to measure the AP and lateral alpha angles, femoral head-neck offset, and Southwick angle preoperatively and at the latest clinical visit. The Heyman and Herndon clinical outcome, complications, and subsequent hip surgeries were recorded. Results At latest followup, the median AP alpha angle (52°, range 41°-59°versus 76°, interquartile range [IQR]: 68°-

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“…Surgical dislocation has been promoted to treat severe SUFE with a low FHO [33][34][35][36][37] however pooled data from 5 studies (SD) [13,15,[28][29][30] showed a high rate of FHO (25%). This rate was comparable to closed reduction and internal fixation.…”

Section: Discussionmentioning

confidence: 99%

“…A number of treatments options were reported for the study population including epiphysiodesis [10,11], pinning in situ (PIS) [1,7,[12][13][14][15][16][17][18][19], closed reduction and pinning (CRIF) [4,5,11,15,16,18,[20][21][22][23][24][25], open reduction and physeal osteotomy (PO) [1,7,15,26] open reduction and internal fixation (ORIF) [23][24][25]27] and surgical dislocation (SD) [13,15,[28][29][30].…”

Section: Description Of Studiesmentioning

confidence: 99%

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

et al. 2018

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The Role of Capital Realignment Versus In Situ Stabilization for the Treatment of Slipped Capital Femoral Epiphysis

Abstract: Level III retrospective comparative study.

Cited by 68 publications

References 41 publications

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

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

Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

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