Capital realignment for moderate and severe SCFE using a modified Dunn procedure.
Moderate to severe slipped capital femoral epiphysis leads to premature osteoarthritis resulting from femoroacetabular impingement. We believe surgical correction at the site of deformity through capital reorientation is the best procedure to fully correct the deformity but has traditionally been associated with high rates of osteonecrosis. We describe a modified capital reorientation procedure performed through a surgical dislocation approach. We followed 40 patients for a minimum of 1 year and 3 years from two institutions. No patient developed osteonecrosis or chondrolysis. Slip angle was corrected to 4 degrees to 8 degrees and the mean alpha angle after correction was 40.6 degrees. Articular cartilage damage, full-thickness loss, and delamination were observed at the time of surgery, especially in the stable slips. This technique appears to have an acceptable complication rate and appears reproducible for full correction of moderate to severe slipped capital femoral epiphyses with open physes.
Ziebarth
Kai
K
Department of Pediatric Surgery, Universitätsklinik Inselspital, University of Berne, Berne, Switzerland.
Zilkens
Christoph
C
Spencer
Samantha
S
Leunig
Michael
M
Ganz
Reinhold
R
Kim
Young-Jo
YJ
D000293:Adolescent; D001900:Boston; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects; D010020:Osteonecrosis / Q000209:etiology; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome