|Beitragstitel||First case of bilateral, simultaneous, acute on chronic, unstable slipped capital femoral epiphysis (SCFE) treated with modified Dunn procedure|
Bilaterality of slipped capital femoral epiphysis is reported in 18 – 50% in literature, whereby sequential occurrence is more often seen than simultaneous SCFE. Almost 50 – 60% of children with bilateral SCFE presents a simultaneous involvement but they are often stable.
In literature as well as in our database we could not found any case which should a bilateral, simultaneous, acute on chronic, unstable slipped capital femoral epiphysis.
We would like to present such a case which we recently treated.
A 15 years old adolescent, African origin, addressed by the family doctor, with bilateral inguinale hip pain since 2 - 3 months showed an acute pain exacerbation after weeks of physiotherapy without pain relief. The clinical examination showed a painful, bilateral reduced flexion, internal/external rotation of 70-0-0°, limited abduction. Radiological assessment presents a bilateral severe slipped capital femoral epiphysis. Based on that we performed a bilateral modified Dunn procedure. The more severe SCFE was operated as first case. The contralateral side was temporary fixed with a k-wire and was definitively treated at the fifth postoperative day.
Intraoperatively the typical antero-superior chondrolabral lesions could be seen. The hips showed a hinged abduction. The epiphysis was in both hips unstable. Callus formation of the metaphysis was visible and reduced during modified Dunn procedure to reduced tension of the vessels. On both sides the epiphysis was vascularized before and after reduction and showed bleeding after we performed a drill holes at the level of the epiphysis. Intraoperatively an impingement free range could be obtained.
This patient is the first case in which we see a bilateral, simultaneous, unstable, slipped capital femoral epiphysis treated with the modified Dunn procedure. Long-term follow-ups and evaluations will be interesting to evaluate avascular necrosis, quality of life and clinical function of the hip joints.