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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(04): e632-e638
DOI: 10.1055/s-0042-1758362
Artigo Original
Ortopedia Pediátrica

Modified Dunn Technique for Unstable Slipped Capital Femoral Epiphysis: A Midterm Single Center Experience[*]

Article in several languages: português | English
Frederico Coutinho de Moura Vallim 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Henrique Abreu da Cruz 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Carlos Francisco Bittencourt Silva 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Caroline Sandra Gomes de Abreu 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Ricardo Carneiro Rodrigues 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Marcio Garcia Cunha 
2   Médico Ortopedista, Chefe da Ortopedia Pediátrica, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
› Author Affiliations Financial Support The authors declare that they have received no financial support to prepare the present manuscript.
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Abstract

Objective To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil.

Methods We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects.

Results Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively (p < 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02–1.07; p < 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development (p = 0.82).

Conclusion The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.

Keywords

slipped capital femoral epiphysis - femoral head necrosis - osteotomy - hip

* Study conducted at Hospital Estadual da Criança, Rio de Janeiro, RJ, Brazil.




Publication History

Received: 10 March 2022

Accepted: 12 September 2022

Article published online:
21 July 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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