Lerch, Till D; Boschung, Adam; Leibold, Christian; Kalla, Roger; Kerkeni, Hassen; Baur, Heiner; Eichelberger, Patric; Steppacher, Simon D; Liechti, Emanuel F; Siebenrock, Klaus A; Tannast, Moritz; Ziebarth, Kai (2022). Minimal Out-Toeing and Good Hip Scores of Severe SCFE Patients Treated With Modified Dunn Procedure and Contralateral Prophylactic Pinning at Minimal 5-year Follow up Journal of Pediatric Orthopaedics, 42(5), e421-e426. Wolters Kluwer 10.1097/BPO.0000000000002127
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Background: Slipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the modified Dunn procedure have out-toeing at follow up.Therefore, we used instrumented gait analysis and questioned (1) do severe SCFE patients treated with a modified Dunn procedure have symmetrical foot progression angle (FPA) compared with contralateral side and compared with asymptomatic volunteers (2) what is the prevalence of out-toeing gait and what are the outcome socres at follow up. Methods: Gait analysis of 22 patients (22 hips) treated with an unilateral modified Dunn procedure for severe SCFE (slip angle >60 degrees, 2002 to 2011) was retrospectively evaluated. Of 38 patients with minimal 5-year follow up, 2 hips (4%) had avascular necrosis of the femoral head and were excluded for gait analysis. Twenty-two patients were available for gait analysis at follow up (mean follow up of 9±2 y). Mean age at follow up was 22±3 years. Mean preoperative slip angle was 64±8 degrees (33% unstable slips) and decreased postoperatively (slip angle of 8±4 degrees). Gait analysis was performed with computer-based instrumented walkway system (GAITRite) to measure FPA with embedded pressure sensors. Patients were compared with control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29±6 y). Results: (1) Mean FPA of SCFE patients (3.6±6.4 degrees) at follow up was not significantly different compared with their contralateral side (5.6±5.5 degrees) and compared with FPA of controls (4.0±4.5 degrees). (2) Of the 22 SCFE patients, most of them (19 hips, 86%) had normal FPA (-5 to 15 degrees), 2 patients had in-toeing (FPA<-5 degrees) and 1 had out-toeing (FPA >15 degrees) and was not significantly different compared with control group. (3) Mean modified Harris hip score (mHHS) was 93±11 points, mean Hip Disability and Osteoarthritis Outcome Score (HOOS) score was 91±10 points. Three patients (14%) had mHHS <80 points and walked with normal FPA. The 2 patients with in-toeing and one patient with out-toeing had mHHS >95 points. Conclusions: Patients with severe SCFE treated with modified Dunn procedure had mostly symmetrical FPA and good hip scores at long term follow up. This is in contrast to previous studies. Although 1 patient had out-toeing and 2 patients had in-toeing at follow up, they had good hip scores. Level of evidence: Level III-retrospective comparative study.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
School of Health Professions School of Health Professions > Physiotherapy School of Health Professions > Physiotherapy > Foot Biomechanics and Technology School of Health Professions > Physiotherapy > Neuromuscular Control |
Name: |
Lerch, Till D; Boschung, Adam; Leibold, Christian; Kalla, Roger; Kerkeni, Hassen; Baur, Heiner  0000-0002-4780-225X; Eichelberger, Patric 0000-0003-2223-6113; Steppacher, Simon D; Liechti, Emanuel F; Siebenrock, Klaus A; Tannast, Moritz and Ziebarth, Kai |
Subjects: |
Q Science > QP Physiology R Medicine > RC Internal medicine > RC1200 Sports Medicine R Medicine > RD Surgery R Medicine > RZ Other systems of medicine |
ISSN: |
0271-6798 |
Publisher: |
Wolters Kluwer |
Funders: |
[UNSPECIFIED] University of Bern ; [7] Swiss National Science Foundation |
Language: |
English |
Submitter: |
Heiner Baur |
Date Deposited: |
12 Sep 2022 15:03 |
Last Modified: |
12 Sep 2022 15:03 |
Publisher DOI: |
10.1097/BPO.0000000000002127 |
Related URLs: |
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PubMed ID: |
35250015 |
ARBOR DOI: |
10.24451/arbor.17694 |
URI: |
https://arbor.bfh.ch/id/eprint/17694 |
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