title: The anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis by modified Dunn subcapital osteotomy using the Ganz approach: functional and radiological outcomes.
abstract: OBJECTIVE
  This study analysed the clinical and radiological outcome of anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis (SCFE) treated by subcapital osteotomy (a modified Dunn osteotomy) through the surgical approach described by Ganz.
  
  
  METHODS
  We prospectively studied 31 patients (32 hips; 16 females and five males; mean age 14.3 years) with SCFE. On the Southwick classification, ten were of moderate severity (head-shaft angle > 30° to 60°) and 22 were severe (head-shaft angle > 60°). Each underwent open reduction and internal fixation using an intracapsular osteotomy through the physeal growth plate after safe surgical hip dislocation. Unlike the conventional procedure, 25 hips did not need an osteotomy of the apophysis of the great trochanter and were managed using an extended retinacular posterior flap.
  
  
  RESULTS
  Clinical outcome was assessed using the range of movement and the Harris Hip (HHS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and Merle d'Aubigné scores, while radiological measurements included slip and alpha angles. The mean duration of follow-up was 24.1 months (12 to 40). There was a significant improvement in all clinical and radiological measurements after treatment (p < 0.001). Post-operative major complications were one deep infection and one case of femoral head collapse.
  
  
  CONCLUSIONS
  These findings suggest that a modified Dunn osteotomy carried out through Ganz approach is a safe and effective method of treating the stable SCFE with a high degree of slip. Cite this article: Bone Joint J 2016;98-B:1283-8.
authors: Cairo University, 1 Kasr Alainy Hospital, El Manial, Cairo 11562, Egypt.
authors: A H
authors: AH
authors: Abdelazeem
authors: Cairo University, 1 Kasr Alainy Hospital, El Manial, Cairo 11562, Egypt.
authors: F K
authors: FK
authors: Beder
authors: Cairo University, 1 Kasr Alainy Hospital, El Manial, Cairo 11562, Egypt.
authors: M M
authors: MM
authors: Abdel Karim
authors: Cairo University, 1 Kasr Alainy Hospital, El Manial, Cairo 11562, Egypt.
authors: H
authors: H
authors: Abdelazeem
authors: Cairo University, 1 Kasr Alainy Hospital, El Manial, Cairo 11562, Egypt.
authors: H
authors: H
authors: Abdel-Ghani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D060048:Slipped Capital Femoral Epiphyses / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Capital; Dunn; Epiphysis; Femoral; High; Slipped; Stable; Surgical dislocation; Upper