A 14-year-old female presented with a one-week history of mild, vague left hip pain which acutely worsened after a fall at school. Radiographs revealed a severe, unstable slipped capital femoral epiphysis (SCFE) (Figure 1).
She was taken urgently to the operating room and underwent a modified Dunn procedure (open subcapital realignment via a surgical dislocation approach.) Following six weeks of crutch-protected weight-bearing followed by hips-pecific physical therapy rehabilitation, the patient ultimately returned to full activity with no evidence of postoperative complication at one-year follow-up appointment (Figures 2 and 3).
From November 2006 to July 2013, the Department of Orthopaedics at Nationwide Children’s managed 31 consecutive unstable SCFEs via the modified Dunn approach. At a mean follow-up of 22.5 months, only two patients (6%) have developed osteonecrosis. Low rates of complication have been documented, including three patients (10%) with mild heterotopic bone and four patients (13%) with symptomatic hardware. No hardware failure, postoperative instability or nonunion has occurred. Radiographic analysis has shown restoration of the slip angle with minimal change in greater trochanteric height and femoral neck length. This represents the largest, single-center consecutive series of patients managed with the modifed Dunn procedure for unstable SCFE. The series’ results reveal the safety and efficacy of our department’s approach to these patients.
New Standard of Care
Surgical dislocation techniques are now being utilized for the management of many pediatric hip disorders. Hip impingement disorders, residual deformities related to Perthes and SCFE, femoral neck osteochondromas, post traumatic acetabular and femoral head fractures, and labral pathologies are now successfully being managed in improved ways, building upon such hip preservation techniques as periacetabular osteotomy, redirectional femoral and pelvic osteotomies, hip arthroscopy and hip distraction methods that are currently being performed at Nationwide Children’s.