Dunn, J Bone Joint Surg Br 1964 - The Treatment of Adolescent Slipping of the Upper Femoral Epiphysis

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The Treatment of Adolescent Slipping of the Upper Femoral Epiphysis

Dunn·J Bone Joint Surg Br·1964·179 citations·Case series

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Dunn tested whether matching treatment to the clinical type of slipped upper femoral epiphysis, using open cervical neck-shortening osteotomy for severe slips, could restore hip anatomy without injuring the femoral head blood supply. Case series of 41 hips in 31 patients treated by pinning in situ or open reduction, average follow-up 6.5 years, with clinical result as the outcome.

Key Findings

Clinically normal hip at average 6.5 years:
- Pinning in situ: 17/18
- Open reduction: 19/23
Four open-reduction complications: one segmental head necrosis at a nail tip, one avascular necrosis requiring arthrodesis, and two acute cartilage necroses to which Dunn thought technical defects may have contributed.
Dunn divided slips into six presentations. He permitted closed manipulation only for a true acute traumatic slip of a previously normal hip treated within a few hours. All others were pinned in situ or openly corrected.
In chronic and acute-on-chronic slips the retinacular vessels shorten within days. Dunn's osteotomy removes a wedge distal to the physis, including the posterior beak, so the head sits back without vessel tension.
Significance: Dunn described subcapital neck shortening, the Dunn osteotomy, to correct severe slips anatomically while protecting the retinacular blood supply. He argued it restores near-normal hip anatomy where intertrochanteric osteotomy leaves it grossly abnormal, and noted that any advantage against later arthritis was unproven.

Board PearlIn Dunn's series, slips under one-third of the neck diameter were pinned in situ and larger slips were realigned surgically, but cervical osteotomy was contraindicated once the physis had closed.

The Treatment of Adolescent Slipping of the Upper Femoral Epiphysis

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|

The Treatment of Adolescent Slipping of the Upper Femoral Epiphysis

Dunn·J Bone Joint Surg Br·1964·179 citations·Case series

|

Dunn tested whether matching treatment to the clinical type of slipped upper femoral epiphysis, using open cervical neck-shortening osteotomy for severe slips, could restore hip anatomy without injuring the femoral head blood supply. Case series of 41 hips in 31 patients treated by pinning in situ or open reduction, average follow-up 6.5 years, with clinical result as the outcome.

Key Findings

Clinically normal hip at average 6.5 years:
- Pinning in situ: 17/18
- Open reduction: 19/23
Four open-reduction complications: one segmental head necrosis at a nail tip, one avascular necrosis requiring arthrodesis, and two acute cartilage necroses to which Dunn thought technical defects may have contributed.
Dunn divided slips into six presentations. He permitted closed manipulation only for a true acute traumatic slip of a previously normal hip treated within a few hours. All others were pinned in situ or openly corrected.
In chronic and acute-on-chronic slips the retinacular vessels shorten within days. Dunn's osteotomy removes a wedge distal to the physis, including the posterior beak, so the head sits back without vessel tension.
Significance: Dunn described subcapital neck shortening, the Dunn osteotomy, to correct severe slips anatomically while protecting the retinacular blood supply. He argued it restores near-normal hip anatomy where intertrochanteric osteotomy leaves it grossly abnormal, and noted that any advantage against later arthritis was unproven.

Board PearlIn Dunn's series, slips under one-third of the neck diameter were pinned in situ and larger slips were realigned surgically, but cervical osteotomy was contraindicated once the physis had closed.

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