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ABSTRACT Objective: To assess the complications in patients with severe slipped capital femoral epiphysis treated with the Dunn or modified Dunn procedure from 2012 to 2018 at the Institute of Orthopedics and Traumatology, Medical School, Universidade de São Paulo. Methods: Analysis of medical records, preoperative and postoperative radiographs with at least one year of radiographic follow-up of patients with severe slipped capital femoral epiphysis. Results: We reviewed the complications in 19 operated cases from 2012 to 2018, out of which 36.8% had osteonecrosis of the femoral head, one patient had chondrolysis, and another had postoperative infection. Conclusion: The osteonecrosis rate observed in this series of cases is similar to that described in other orthopedic facilities. We assessed factors that could potentially influence this outcome, including other characteristics of the patient (obesity, endocrine diseases, and history of sports activities) and of the health system. Level of Evidence III, Restropective Case Series.
RESUMO Objetivo: Avaliar as complicações apresentadas nos pacientes com epifisiolistese grave tratados por meio do procedimento de Dunn ou Dunn Modificado entre 2012 e 2018 no IOT-FMUSP. Métodos: Análise de prontuários, radiografias pré-operatórias e radiografias pós-operatórias com pelo menos 1 ano de seguimento radiográfico dos pacientes com epifisiolistese grave. Resultados: Analisou-se a presença de complicações em 19 casos operados de 2012 a 2018. Desses pacientes, 36,8% apresentaram osteonecrose da cabeça femoral, oi observada condrólise em 1 paciente e infecção pós-operatória em 1 paciente. Conclusão: A taxa de osteonecrose observada nesta série de casos está próxima à descrita em outros serviços. Alguns fatores que potencialmente influenciariam neste desfecho poderiam ter sido avaliados, como outras características do paciente (obesidade, doenças endócrinas e atividade esportiva) e do sistema de saúde. Nível de Evidência III, Série Retrospectiva de Casos .
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@#clavicular joint (ACJ) injuries remains controversial. Themodified Weaver-Dunn (WD) procedure is one of thefrequently used techniques. Recently when it was comparedwith anatomical autogenous tendon graft reconstructionprocedures, the results were inferior. However, theseanatomical procedures are technically more demanding withsmall margin of error and they have tendency forpostoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VIACJ dislocations were treated by modified WD procedureusing non-absorbable synthetic suture passed through thebase of coracoid process for augmentation of transferredcoraco-acromial (CA) ligament. Functional outcome wasassessed using the Oxford Shoulder Score, NottinghamClavicular Score and Visual Analog Score (VAS) at the finalfollow-up after surgery.Results: The mean pre-operative Oxford Shoulder Scoreimproved from 25.22±2.64 (range 20 to 30) to 44.75±1.99(range 40 to 48) and mean pre-operative NottinghamShoulder Score improved from 49.25±4.91 (range 39 to 58)to 87.27±4.39 (range 79 to 96) at last follow-up after surgerywith p-value <0.001. Thirty-five (87.5%) patients hadexcellent outcomes, four (10%) patients had good outcomesand one (2.5%) patient had fair outcome. Thirty-eight (95%)patients had no pain while two (5%) had moderate painbased on VAS score.Conclusion: Modified Weaver-Dunn is a simple wellestablished technique for grade IV to VI ACJ dislocation.We cannot consider this procedure as old and outdated on theargument that the long term functional outcomes are notsubopti
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Objective To compare the biomechanical behavior of a triple Endobutton technique for anatomic reconstruction of coracoclavicular ligament and with a modified Weaver-Dunn procedure. Methods Twelve fresh frozen cadaveric shoulders were applied with 70 N in superior, anterior and posterior direction, respectively, to measure displacement of the acromioclavicular joint. The failure test with the load at the rate of 25 mm/min was conducted to record the failure load and failure mode. The specimens were then randomly assigned to 2 groups: the triple Endobutton technique group and the modified Weaver-Dunn procedure group for reconstruction and to conduct displacement test and failure test again. The stability and mechanical strength of acromioclavicular joints after reconstruction under different states were then compared. Results The triple Endobutton technique group had significantly less anterior ((8.72±1.41) mm vs (37.03±5.05) mm) and posterior ((8.03±3.68) mm vs (14.85±1.89) mm) displacement than that in the modified Weaver-Dunn procedure group after reconstruction (P<0.05), and the former had similar displacement ((7.81±2.22) mm anterior and (7.16±1.95) mm posterior) as compared to the intact state. There were no significant differences in superior displacement among the groups. The modified Weaver-Dunn procedure group had significantly smaller failure loads ((172±9) N) than that in the triple Endobutton technique group ((687±115) N) and the intact ligament group ((685±234) N) (P<0.05). Conclusions The triple Endobutton technique has less anterior and posterior displacement and its stability is more closely approximate to the intact ligament; meanwhile, it has similar strength as coracoclavicular ligaments, which can better restore the function of coracoclavicular ligaments.