Traumatic Unstable Acute on Chronic Slipped Capital Femoral Epiphysis Managed with Modified Dunn’s Procedure: A Case Report

Abstract

Introduction: Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder. In case of an unstable slip, the line of management is still a controversy. Mismanagement may result in consequences of poor hip function.
Case History: A 15-year-old obese boy presented with left sided hip pain of one-year duration. Examination and radiographs revealed a stable chronic slip and he was advised in situ pinning. The patient refused surgery. After one month he presented with severe pain over the left hip following a fall. He was unable to weight bear and had severe restriction of movements of left hip. Plain radiographs and MR imaging was suggestive of unstable acute on chronic SCFE. We proceeded with a modified Dunn’s procedure. At 3 year follow up he has painless hip with full range of movements with no clinical or radiological signs of osteonecrosis.
Conclusion: Open reduction utilizing safe surgical dislocation of hip is the treatment of choice in an unstable SCFE. Closed reduction is associated with increased incidence of osteonecrosis of femoral head.