Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Authors

  • Bohdan Romanyshyn Western Ukrainian Specialized Children’s Medical Centre, Lviv, Ukraine
  • Alexander Schchurovsky Western Ukrainian Specialized Children’s Medical Centre, Lviv, Ukraine
  • G. Ulrich Exner Orthopaedie Zentrum Zuerich Hirslanden Klinik im Park. Switzerland, Switzerland

DOI:

https://doi.org/10.15674/0030-59872023498-102

Keywords:

open reduction DUNN’s method

Abstract

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

Author Biographies

Bohdan Romanyshyn, Western Ukrainian Specialized Children’s Medical Centre, Lviv

MD

Alexander Schchurovsky, Western Ukrainian Specialized Children’s Medical Centre, Lviv

MD, PhD

G. Ulrich Exner, Orthopaedie Zentrum Zuerich Hirslanden Klinik im Park. Switzerland

Prof.

References

  1. Dunn, D. M. (1964). The treatment of adolescent slipping of the upper femoral epiphysis. The Journal of Bone and Joint Surgery, 46-B(4), 621–629. https://doi.org/10.1302/0301-620x.46b4.621
  2. Galletta, C., Aprato, A., Giachino, M., Marre’ Brunenghi, G., Boero, S., Turchetto, L., & Massè, A. (2022). Modified Dunn procedure versus percutaneous pinning in moderate/severe stable slipped capital femoral epiphyses. HIP International, 32, 813–819. https://doi.org/10.1177/11207000211004862
  3. Exner, G. U. (1986). Growth and Pubertal Development in Slipped Capital Femoral Epiphysis: A Longitudinal Study. Journal of Pediatric Orthopaedics, 6(4), 403–409. https://doi.org/10.1097/01241398-198607000-00003
  4. Schai, P. A., Exner, G. U., & Hänsch, O. (1996). Prevention of secondary coxarthrosis in slipped capital efemoral epiphysis: a long-term follow-up study after corrective intertrochanteric osteotomy. J. Pediat.r Orthop. B., 5, 135–143. https://doi.org/10.1097/01202412-199605030-00001
  5. Ganz, R., Gill, T. J., Gautier, E., Ganz, K., Krügel, N., & Berlemann, U. (2001). Surgical dislocation of the adult hip. The Journal of Bone and Joint Surgery. British volume, 83-B(8), 1119–1124. https://doi.org/10.1302/0301-620x.83b8.0831119
  6. Kalhor, M., Horowitz, K., Gharehdaghi, J., Beck, M., & Ganz,R. (2012). Anatomic Variations in Femoral Head Circulation. HIP International, 22(3), 307–312. https://doi.org/10.5301/hip.2012.9242
  7. Gautier, E., Ganz, K., Krügel, N., Gill, T., & Ganz, R. (2000). Anatomy of the medial femoral circumflex artery and its surgical implications. The Journal of Bone and Joint Surgery. British volume, 82-B(5), 679–683. https://doi.org/10.1302/0301-620x.82b5.0820679
  8. Ziebarth, K., Leunig, M., Slongo, T., Kim, Y.-J., & Ganz, R. (2013). Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery. Clinical Orthopaedics and Related Research®, 471(7), 2156–2162. https://doi.org/10.1007/s11999-013-2818-9
  9. Fournier, A., Monget, F., Ternynck, C., Fron, D., Mezel, A., Herbaux, B., Canavese, F., & Nectoux, E. (2022). Comparison between anterior cuneiform osteotomy and Dunn procedure in the surgical management of unstable severe slipped femoral epiphysis: A case-control study of 41 patients. Orthopaedics & Traumatology: Surgery & Research, 108(1), 103167. https://doi.org/10.1016/j.otsr.2021.103167
  10. Cheok, T., Smith, T., Berman, M., Jennings, M., Williams, K., Poonnoose, P. M., Rawat, J., & Foster, B. (2022). Is the modified Dunn’s procedure superior to in situ fixation? A systematic review and meta-analysis of comparative studies for management of moderate and severe slipped capital femoral epiphysis. Journal of Children's Orthopaedics, 16(1), 27–34. https://doi.org/10.1177/18632521221078864
  11. Abdelazeem, A. H., Beder, F. K., Abdel Karim, M. M., Abdelazeem, H., & Abdel-Ghani, H. (2016). The anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis by modified Dunn subcapital osteotomy using the Ganz approach. The Bone & Joint Journal, 98-B(9), 1283–1288.
  12. https://doi.org/10.1302/0301-620x.98b9.37071
  13. Gorgolini, G., Caterini, A., Efremov, K., Petrungaro, L., De Maio, F., Ippolito, E., & Farsetti, P. (2021). Surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz: a systematic review. BMC Musculoskeletal Disorders, 22(S2), 1064. https://doi.org/10.1186/s12891-022-05071-9
  14. Passaplan, C., Gautier, L., & Gautier, E. (2020). Longterm follow-up of patients undergoing the modified Dunn procedure for slipped capital femoral epiphysis. Bone & Joint Open, 1(4), 80–87. https://doi.org/10.1302/2046-3758.14.bjo-2020-0010.r1
  15. Tibor, L. M., & Sink, E. L. (2013). Risks and Benefits of the Modified Dunn Approach for Treatment of Moderate or Severe Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics, 33, S99—S102. https://doi.org/10.1097/bpo.0b013e3182860050
  16. Leunig, M., Slongo, T., Kleinschmidt, M., & Ganz, R. (2007). Subcapital Correction Osteotomy in Slipped Capital Femoral Epiphjysis by Means of Surgical Hip dislocation. Oper. Orthop. Traumatol, 19(4), 389–410
  17. Tomaru, Y., Kamada, H., Tsukagoshi, Y., Nakagawa, S., Onishi, M., Tanaka, K., Takeuchi, R., Mataki, Y., Miyakawa, S., & Yamazaki, M. (2019). Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis. Journal of Rural Medicine, 14(2), 191–195. https://doi.org/10.2185/jrm.3011
  18. Fish, J. B. (1994). Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. The Journal of Bone & Joint Surgery, 76(1), 46–59. https://doi.org/10.2106/00004623-198466080-00002
  19. Velasco, R., Schai, P. A., & Exner, G. U. (1998). Slipped Capital Femoral Epiphysis: A Long-term Follow-up Study after Open Reduction of the Femoral Head Combined with Subcapital Capital Wedge Resection. J. Pediatric Orthop. B., 7, 43–52.
  20. Aronson, D. D., Peterson, D. A., & Miller, D. V. (1992). Slipped capital femoral epiphysis: the case for internal fixation in situ. Clin. Orthop. Relat. Res, 281, 115–122.

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How to Cite

Romanyshyn, B. ., Schchurovsky, A. ., & Ulrich Exner, G. . . (2024). Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (4), 98–102. https://doi.org/10.15674/0030-59872023498-102

Issue

No. 4 (2023)

Section

SHORT REPORTS AND NEWS FROM PRACTICE

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