The treatment of severe slipped capital femoral epiphysis via the Ganz surgical dislocation and anatomical reduction

Abstract

We present our experience of the modified Dunn procedure in combination with a Ganz surgical dislocation of the hip to treat patients with severe slipped capital femoral epiphysis (SCFE). The aim was to prospectively investigate whether this technique is safe and reproducible. We assessed the degree of reduction, functional outcome, rate of complications, radiological changes and range of movement in the hip. There were 28 patients with a mean follow-up of 38.6 months (24 to 84). The lateral slip angle was corrected by a mean of 50.9° (95% confidence interval 44.3 to 57.5). The mean modified Harris hip score at the final follow-up was 89.1 (sd 9.0) and the mean Non-Arthritic Hip score was 91.3 (sd 9.0). Two patients had proven pre-existing avascular necrosis and two developed the condition post-operatively. There were no cases of nonunion, implant failure, infection, deep-vein thrombosis or heterotopic ossification. The range of movement at final follow-up was nearly normal. This study adds to the evidence that the technique of surgical dislocation and anatomical reduction is safe and reliable in patients with SCFE.

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

“…It is unclear, however, whether revascularization was related to the integrity of the retinacular vessels or if it may have happened through a transphyseal mechanism. Contrary to previous studies [9,18,30], we found three patients with an ICP waveform before dissection and after fixation who later developed osteonecrosis. These represent examples of a false-negative test result.…”

“…However, a descriptive analysis of the raw measurements of accuracy showed that ICP monitoring before dissection demonstrated good sensitivity, whereas bleeding after definitive fixation was a highly (100%) specific test. The absence of femoral head perfusion after fixation was also found to have high specificity by Madan et al [18] who reported osteonecrosis in four our of 17 patients with unstable SCFE who had no bleeding before dislocation and after reduction. Similarly, Sankar et al [24] found no perfusion after fixation in three of 27 unstable SCFEs.…”

“…One of the advantages of the modified Dunn procedure is the ability to perform an intraoperative assessment of epiphyseal perfusion and controlled reduction of the epiphysis preserving its blood supply. However, there is limited evidence [18,30] about the performance of epiphyseal perfusion assessment in screening for osteonecrosis. In this study, we investigated the accuracy of intraoperative assessment of femoral head vascularity by examining the presence of active bleeding and using an ICP monitor as an indicator for osteonecrosis development in patients undergoing a modified Dunn procedure for the treatment of unstable SCFE while assessing clinical features as possible prognostic factors.…”

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

“…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.…”

“…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].…”