Is Surgical Hip Dislocation Necessary in Slip Reduction? The Preliminary Results of Extended Dunn Technique in Slipped Capital Femoral Epiphysis

Article Information

Title: Is Surgical Hip Dislocation Necessary in Slip Reduction? The Preliminary Results of Extended Dunn Technique in Slipped Capital Femoral Epiphysis

Authors: Ung Sia, Yun Han Gan, Mohd Anuar Ramdhan Ibrahim

Journal: Journal of the Dow University of Health Sciences (JDUHS)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30

Publisher: DOW University of Health Sciences, Karachi

Country: Pakistan

Year: 2023

Volume: 17

Issue: 3

Language: English

DOI: 10.36570/jduhs.2023.3.1739

Keywords: Extended DunnSlipped Capital Femoral EpiphysisSevere Slip SCFE

Abstract

Treatment of severe Slipped Capital Femoral Epiphysis (SCFE) using the Modified Dunn technique has become a preferred method, but it carries a steep learning curve. We introduce an alternative technique whereby surgical realignment is performed without a surgical hip dislocation. This series involved five cases (6 hips) of moderate to severe SCFE (slip angle 450 to 600). This series reviewed the short-term complications, functional status, avascular necrosis, and chondrolysis. Slip severity was moderate in two hips and severe in four hips. Five out of six hips demonstrated satisfactory functional and radiological outcomes. Only one patient with an absence of pre-reduction femoral head bleeding developed avascular necrosis. None experienced slip progression or chondrolysis. In the treatment of severe SCFE, the Extended Dunn is a less traumatic technique, easier to master when compared to other techniques with short-term functional outcome and complication rate comparable to that of Modified Dunn technique.

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Research Objective

To describe and illustrate the surgical technique of the extended Dunn procedure for treating slipped capital femoral epiphysis (SCFE), focusing on retinacular flap development, physeal clearance, and femoral head reduction.

Methodology

Surgical technique description illustrated with figures showing the development of posterior and anterior retinacular flaps, separation of the metaphysis from the epiphysis, physeal clearance and neck shortening, and reduction, fixation, and drilling of the femoral head to assess perfusion.

Methodology Flowchart

                        graph TD;
    A["Develop Retinacular Flaps"] --> B["Separate Metaphysis from Epiphysis"];
    B --> C["Clear Physis and Shorten Neck"];
    C --> D["Reduce and Fix Femoral Head"];
    D --> E["Assess Perfusion"];

Discussion

The figures illustrate key steps in the extended Dunn procedure, emphasizing the anatomical considerations and surgical maneuvers required for successful reduction and fixation in SCFE.

Key Findings

The extended Dunn procedure involves developing retinacular flaps, separating the metaphysis from the epiphysis, clearing the physis, shortening the femoral neck, and reducing the femoral head.

Conclusion

The extended Dunn procedure is a surgical technique for SCFE that involves specific steps for retinacular flap creation, physeal management, and femoral head reduction.

Fact Check

- The publication is from "J Dow Univ Health Sci 2023, Vol. 17 (3): 161-167".
- Figure 1 illustrates the development of posterior and anterior retinacular flaps.
- Figure 3 shows physeal clearance and neck shortening.

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