Retrospective two-institution study of 40 patients with moderate-to-severe SCFE treated with the modified Dunn procedure. The technique combines Dunn's subcapital realignment with Ganz's surgical hip dislocation and an extended retinacular flap to protect femoral head vascularity. The study asks whether capital realignment at the site of deformity can be performed with an acceptable complication profile.
For decades, osteonecrosis rates up to 100% made subcapital realignment for severe SCFE essentially indefensible. Most surgeons accepted residual deformity via in situ pinning or shifted correction proximally with intertrochanteric osteotomy — both of which leave cam deformity at the head-neck junction and set the stage for femoroacetabular impingement.
Zero osteonecrosis across 40 cases at two centers changed that calculus. When you see moderate-to-severe SCFE (slip angle greater than 30°), especially unstable SCFE, this paper is the argument for correcting at the source rather than accepting a malunion.
For stable SCFE presenting after months of symptoms, recognize that acetabular cartilage is almost certainly already damaged (25 of 26 hips in this series). Slip severity does not predict chondral injury. Duration of impingement does. This has direct triage implications: earlier intervention matters.
Whether reconstructing a chronically impinged hip truly prevents osteoarthritis is a question this paper raises but cannot answer without long-term follow-up data.
Retrospective two-institution study of 40 patients with moderate-to-severe SCFE treated with the modified Dunn procedure. The technique combines Dunn's subcapital realignment with Ganz's surgical hip dislocation and an extended retinacular flap to protect femoral head vascularity. The study asks whether capital realignment at the site of deformity can be performed with an acceptable complication profile.
For decades, osteonecrosis rates up to 100% made subcapital realignment for severe SCFE essentially indefensible. Most surgeons accepted residual deformity via in situ pinning or shifted correction proximally with intertrochanteric osteotomy — both of which leave cam deformity at the head-neck junction and set the stage for femoroacetabular impingement.
Zero osteonecrosis across 40 cases at two centers changed that calculus. When you see moderate-to-severe SCFE (slip angle greater than 30°), especially unstable SCFE, this paper is the argument for correcting at the source rather than accepting a malunion.
For stable SCFE presenting after months of symptoms, recognize that acetabular cartilage is almost certainly already damaged (25 of 26 hips in this series). Slip severity does not predict chondral injury. Duration of impingement does. This has direct triage implications: earlier intervention matters.
Whether reconstructing a chronically impinged hip truly prevents osteoarthritis is a question this paper raises but cannot answer without long-term follow-up data.