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CASE REPORT

Nationwide Children's Hospital

The modified Oxford bone score can predict the risk of developing contralateral slipped capital femoral epiphysis (SCFE) in children who present with a unilateral slip. Studies have shown that this scoring system, which evaluates skeletal maturity, helps in assessing the likelihood of a slip occurr...ing in the opposite hip. Early identification through this method allows for timely intervention and monitoring, potentially reducing complications associated with SCFE.

Loder classification is the best functional classification to guide treatment for SCUFE.For the other hip prophylaxis fixation at the same time if it is painful ,obese child ,>10yr old,increase retroversion,metabolic diseases .For the modified DUNN OT is better to preseve the main posterior blood su...pply.

@David Brown, David, you won the 2023 Best Practice Name Award - OuchOrtho - I love it.

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Amazing case. Amazing skill. I do not routinely do these cases, but have some questions as this condition is fascinating to me. Is there any role in using heparin during surgery to prevent AVN while working with the ascending branch of the medial circumflex artery? How do you manage the capsule?... Do you routinely create and leave an aggressive capsulotomy to limit intracapsular post operative pressures? Is there any role for an MRI or MRA pre-operatively to assess viability of the femoral head and its vascularity? Thanks again for a fascinating teaching case.

I would like to commend Dr. Smith for the excellent technique, images, and outcome on this case. Superb job. I have not done the Modified Dunn procedure for SCFE mostly due to anecdotal observations of catastrophic postoperative AVN that may occur. Of course in general it's better to make deci...sions based on peer reviewed literature, I wonder if the results of this procedure are much worse in the unreported/unstudied patients. While one could make this argument for any surgery, if I could get the unreported results of 10 procedures, the Modified Dunn would be my first choice. It is certainly possible that the complication rate of the Modified Dunn has decreased with tools such as monitoring intraoperative perfusion and I am biased by early results. This is one benefit of participating in surgeon dashboards like Setting Scoliosis Straight. We know results from Drs. Lenke, Lonner, and Newton as they are widely reported, but these databases provide the opportunity to compare ourselves to a larger, less reported group.

PMID: 20154561 J Trauma. 2010 Feb;68(2):481-4.

Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

ABSTRACT
- Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.