{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:28:11Z","timestamp":1789028891651,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequately treated. While in situ pinning remains the standard treatment for mild slips, it fails to correct the deformity in moderate and severe cases, potentially predisposing to degenerative changes. The modified Dunn procedure (MDP) was developed to restore proximal femoral anatomy through surgical hip dislocation while preserving vascular supply.<\/jats:p>\n                    <jats:p>The aim of the study is to evaluate the long-term radiological and functional outcomes of the MDP in patients with moderate (14 cases) and severe (10 cases) SCFE, and to assess the incidence of avascular necrosis (AVN), osteoarthritis, and other complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective case series was conducted between August 2015 and January 2019 at a single tertiary institution. A total of 24 hips with moderate-to-severe SCFE and open physis were treated using the MDP via surgical hip dislocation. Mild and acute-only slips were excluded. MDP was used as a primary procedure, performed early in severe slips and in selected moderate slips after clinical assessment. Patients were followed clinically and radiologically for a mean duration of 84\u2009\u00b1\u20092.6\u00a0months (range 80\u201388 months). Functional outcomes were assessed using the Harris Hip Score (HHS) and Merle d\u2019Aubign\u00e9 and Postel score. Radiographic outcomes and complications, including AVN and secondary arthritis, were documented. Fixation was performed using Schanz screws, cannulated screws, or K-wires according to intraoperative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean preoperative slip angle (48.3\u00b0\u2009\u00b1\u20097.2\u00b0) significantly improved postoperatively (11.4\u00b0\u2009\u00b1\u20093.1\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). HHS improved from a preoperative mean of 70.4\u2009\u00b1\u20095.8 to 92.9\u2009\u00b1\u20094.2 at final follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The Merle d\u2019Aubign\u00e9 and Postel score improved from 13.8\u2009\u00b1\u20091.6 preoperatively to 17.5\u2009\u00b1\u20090.9 at final follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). AVN developed in 4 out of 24 hips (16.7%). Arthritis developed in 2 out of 24 hips (8.3%, degenerative OA; no septic arthritis or chondrolysis), representing a total of 6 out of 24 hips (25%) with significant complications when combined with AVN. No cases of postoperative instability or wound infection occurred. Functional scores showed sustained improvement in the majority of patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MDP offers favorable long-term anatomical correction and functional recovery in moderate-to-severe SCFE. However, the risk of AVN and arthritis, particularly in unstable or severe cases, warrants careful patient selection and technical precision. Extended follow-up is essential to detect late complications and evaluate procedural durability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s10195-026-00899-6","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T04:04:14Z","timestamp":1770696254000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-term outcomes of the modified Dunn procedure in moderate and severe slipped capital femoral epiphysis: a prospective case series with 7-year follow-up"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5700-493X","authenticated-orcid":false,"given":"Mahmoud","family":"Fahmy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Hazem","family":"Abdelazeem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa Ahmed","family":"Shawky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"issue":"3","key":"899_CR1","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1007\/s11999-008-0600-z","volume":"467","author":"K Ziebarth","year":"2009","unstructured":"Ziebarth K, Zilkens C, Spencer S, Mamisch N, Kim YJ, Klenke F, Millis MB, Ganz R, Siebenrock KA (2009) Capital realignment for moderate and severe SCFE using a modified dunn procedure. Clin Orthop Relat Res 467(3):704\u2013716. https:\/\/doi.org\/10.1007\/s11999-008-0600-z","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"899_CR2","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1007\/s11999-014-4080-5","volume":"473","author":"EN Novais","year":"2015","unstructured":"Novais EN, Hill MK, Carry PM, Heare TC, Sink EL (2015) Modified dunn procedure is superior to in situ pinning for short-term clinical and radiographic improvement in severe stable SCFE. Clin Orthop Relat Res 473(6):2108\u20132117. https:\/\/doi.org\/10.1007\/s11999-014-4080-5","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"899_CR3","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1080\/17453674.2018.1426365","volume":"89","author":"G Trisolino","year":"2018","unstructured":"Trisolino G, Peta D, Stilli S, Borghi R, Castagnini F, Gigante C (2018) Outcomes of unstable slipped capital femoral epiphysis treated by modified dunn procedure: a multicenter study. Acta Orthop 89(2):211\u2013216. https:\/\/doi.org\/10.1080\/17453674.2018.1426365","journal-title":"Acta Orthop"},{"issue":"1","key":"899_CR4","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s43465-020-00211-4","volume":"55","author":"MV Agashe","year":"2021","unstructured":"Agashe MV, Pinto DA, Vaidya S (2021) Modified dunn osteotomy for moderate and severe SCFE\u2014A retrospective study of thirty hips. Indian J Orthop 55(1):100\u2013108. https:\/\/doi.org\/10.1007\/s43465-020-00211-4","journal-title":"Indian J Orthop"},{"issue":"2","key":"899_CR5","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1097\/BPO.0000000000001116","volume":"39","author":"JJ Masquijo","year":"2019","unstructured":"Masquijo JJ, Allende V, Aponte-Tinao L, Slullitel P (2019) Modified dunn osteotomy for unstable SCFE: multicenter study of 88 hips. J Pediatr Orthop 39(2):71\u201376. https:\/\/doi.org\/10.1097\/BPO.0000000000001116","journal-title":"J Pediatr Orthop"},{"issue":"7","key":"899_CR6","doi-asserted-by":"publisher","first-page":"585","DOI":"10.2106\/JBJS.L.00200","volume":"95","author":"WN Sankar","year":"2013","unstructured":"Sankar WN, Vanderhave KL, Matheney T, Herrera-Soto JA, Karlen JW, Parikh G (2013) The modified Dunn procedure for unstable SCFE: a multicenter perspective. J Bone Joint Surg Am 95(7):585\u2013591. https:\/\/doi.org\/10.2106\/JBJS.L.00200","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"899_CR7","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1097\/BPO.0000000000000194","volume":"34","author":"VV Upasani","year":"2014","unstructured":"Upasani VV, Matheney T, Spencer S, Kim YJ, Millis MB, Kasser JR (2014) Surgical dislocation in the treatment of slipped capital femoral epiphysis: a review of 67 cases. J Pediatr Orthop 34(6):661\u2013667. https:\/\/doi.org\/10.1097\/BPO.0000000000000194","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"899_CR8","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1007\/s00264-018-4179-0","volume":"43","author":"EN Novais","year":"2019","unstructured":"Novais EN, Millis MB, Hill MK, Carry PM, Heare TC, Sink EL (2019) In situ pinning versus modified dunn osteotomy for moderate and severe SCFE. Int Orthop 43(3):669\u2013675. https:\/\/doi.org\/10.1007\/s00264-018-4179-0","journal-title":"Int Orthop"},{"issue":"2","key":"899_CR9","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/BPB.0000000000000883","volume":"31","author":"F Gabana","year":"2022","unstructured":"Gabana F, de Barros Filho TE, da Silva Herrero C, Maranho DA (2022) Modified Dunn procedure in slipped capital femoral epiphysis: results in a Brazilian cohort. J Pediatr Orthop B 31(2):e1\u2013e7. https:\/\/doi.org\/10.1097\/BPB.0000000000000883","journal-title":"J Pediatr Orthop B"},{"issue":"1","key":"899_CR10","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.otsr.2014.09.021","volume":"101","author":"E Nectoux","year":"2015","unstructured":"Nectoux E, Adam V, Karger C, Jehanno P, Mazda K, Pennecot GF (2015) Slipped capital femoral epiphysis: long-term results after in situ fixation. Orthop Traumatol Surg Res 101(1):51\u201354. https:\/\/doi.org\/10.1016\/j.otsr.2014.09.021","journal-title":"Orthop Traumatol Surg Res"},{"issue":"6","key":"899_CR11","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1097\/BPO.0b013e31826f26be","volume":"32","author":"C Alves","year":"2012","unstructured":"Alves C, Steinberg D, Baraka A, Liebergall M, Mosheiff R, Safran O (2012) Surgical dislocation for the treatment of unstable slipped capital femoral epiphysis: clinical results and incidence of avascular necrosis. J Pediatr Orthop 32(6):544\u2013549. https:\/\/doi.org\/10.1097\/BPO.0b013e31826f26be","journal-title":"J Pediatr Orthop"},{"issue":"9","key":"899_CR12","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/BPO.0000000000001189","volume":"39","author":"RL Davis","year":"2019","unstructured":"Davis RL, Samora WP, Persinger F, Klingele KE (2019) Treatment of stable versus unstable slipped capital femoral epiphysis using the modified Dunn procedure. J Pediatr Orthop 39(9):411\u2013415. https:\/\/doi.org\/10.1097\/BPO.0000000000001189","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"899_CR13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/BPO.0000000000000720","volume":"38","author":"F Persinger","year":"2018","unstructured":"Persinger F, Davis RL, Samora WP, Klingele KE (2018) Modified Dunn procedure for unstable SCFE: outcomes and complications. J Pediatr Orthop 38(1):3\u20138. https:\/\/doi.org\/10.1097\/BPO.0000000000000720","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"899_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12891-016-1356-y","volume":"17","author":"A Abdelazeem","year":"2016","unstructured":"Abdelazeem A, Azzam W, Razzak M, Elsheikh A (2016) The modified Dunn procedure for stable slipped capital femoral epiphysis: a prospective case series. BMC Musculoskelet Disord 17(1):1\u20136. https:\/\/doi.org\/10.1186\/s12891-016-1356-y","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"899_CR15","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1302\/1863-2548.15.210161","volume":"15","author":"O Birke","year":"2021","unstructured":"Birke O, Howard JJ, Wissman RD, Badrinath R, Mulpuri K (2021) Modified Dunn procedure in stable SCFE: is it safe and effective? J Child Orthop 15(6):479\u2013487. https:\/\/doi.org\/10.1302\/1863-2548.15.210161","journal-title":"J Child Orthop"},{"issue":"1","key":"899_CR16","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/BPO.0000000000001041","volume":"39","author":"J Sikora-Klak","year":"2019","unstructured":"Sikora-Klak J, Bomar JD, Edmonds EW (2019) A higher incidence of AVN in moderate to severe stable SCFE treated with the modified Dunn procedure. J Pediatr Orthop 39(1):24\u201329. https:\/\/doi.org\/10.1097\/BPO.0000000000001041","journal-title":"J Pediatr Orthop"},{"issue":"5","key":"899_CR17","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1097\/CORR.0000000000000571","volume":"477","author":"TD Lerch","year":"2019","unstructured":"Lerch TD, Todorski IAS, Steppacher SD, Slongo T, Ziebarth K, Tannast M, Siebenrock KA (2019) Slipped capital femoral epiphysis: long-term outcome after surgical treatment with the modified Dunn procedure. Clin Orthop Relat Res 477(5):1191\u20131203. https:\/\/doi.org\/10.1097\/CORR.0000000000000571","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"899_CR18","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00264-017-3405-9","volume":"41","author":"A Aprato","year":"2017","unstructured":"Aprato A, Giachino M, Masse A, Bonani A (2017) Surgical hip dislocation for treatment of SCFE: complications and results. Int Orthop 41(4):851\u2013856. https:\/\/doi.org\/10.1007\/s00264-017-3405-9","journal-title":"Int Orthop"},{"issue":"2","key":"899_CR19","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1302\/1863-2548.15.200216","volume":"15","author":"C Sarassa","year":"2021","unstructured":"Sarassa C, Dallo I, Mosquera P, Ponce R, Escalada F, Carrera G (2021) Medium-term outcomes of the modified Dunn osteotomy for SCFE: risk of residual deformity. J Child Orthop 15(2):104\u2013110. https:\/\/doi.org\/10.1302\/1863-2548.15.200216","journal-title":"J Child Orthop"},{"issue":"5","key":"899_CR20","doi-asserted-by":"publisher","DOI":"10.3390\/children10050778","volume":"10","author":"V Pavone","year":"2023","unstructured":"Pavone V, Testa G, Torrisi P, McCracken KL, Caldaci A, Vescio A, Sapienza M (2023) Diagnosis of slipped capital femoral epiphysis: how to stay out of trouble? Children 10(5):778. https:\/\/doi.org\/10.3390\/children10050778","journal-title":"Children"},{"issue":"6","key":"899_CR21","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1177\/11207000211004862","volume":"32","author":"C Galletta","year":"2022","unstructured":"Galletta C, Aprato A, Giachino M et\u00a0al. (2022) Modified Dunn procedure versus percutaneous pinning in moderate\/severe stable slipped capital femoral epiphyses. Hip Int 32(6):813\u2013819. https:\/\/doi.org\/10.1177\/11207000211004862","journal-title":"Hip Int"},{"issue":"7","key":"899_CR22","doi-asserted-by":"publisher","first-page":"e606","DOI":"10.1097\/BPO.0000000000002960","volume":"45","author":"A Aprato","year":"2025","unstructured":"Aprato A, Giachino M, Boero S et\u00a0al. (2025) In situ pinning with arthroscopic trimming for mild slipped capital femoral epiphysis: a comparative study with traditional in situ pinning and modified Dunn procedure. J Pediatric Orthopaedics 45(7):e606\u2013e613. https:\/\/doi.org\/10.1097\/BPO.0000000000002960","journal-title":"J Pediatric Orthopaedics"},{"key":"899_CR23","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.2106\/00004623-199308000-00002","volume":"75","author":"RT Loder","year":"1993","unstructured":"Loder RT (1993) The epidemiology of slipped capital femoral epiphysis: incidence, demographics, and therapy. J Bone Joint Surg Am 75:1134\u20131140","journal-title":"J Bone Joint Surg Am"},{"key":"899_CR24","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.2106\/00004623-196547060-00001","volume":"47","author":"JJ Fahey","year":"1965","unstructured":"Fahey JJ, O\u2019Brien ET (1965) Acute slipped capital femoral epiphysis: a study of fifty-four cases. J Bone Joint Surg Am 47:1125\u20131137","journal-title":"J Bone Joint Surg Am"},{"key":"899_CR25","doi-asserted-by":"publisher","first-page":"807","DOI":"10.2106\/00004623-196749050-00001","volume":"49","author":"WO Southwick","year":"1967","unstructured":"Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg 49:807\u2013835","journal-title":"J Bone Joint Surg"},{"key":"899_CR26","doi-asserted-by":"publisher","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","volume":"51","author":"WH Harris","year":"1969","unstructured":"Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am 51:737\u2013755","journal-title":"J Bone Joint Surg Am"},{"key":"899_CR27","first-page":"5","volume":"40","author":"R Merle d\u2019Aubign\u00e9","year":"1954","unstructured":"Merle d\u2019Aubign\u00e9 R, Postel M (1954) Functional results of hip surgery. Revue de Chirurgie Orthop\u00e9dique 40:5\u201316","journal-title":"Revue de Chirurgie Orthop\u00e9dique"},{"key":"899_CR28","first-page":"84","volume":"417","author":"R Ganz","year":"2001","unstructured":"Ganz R (2001) Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without risk of avascular necrosis. Clin Orthop Relat Res 417:84\u201392","journal-title":"Clin Orthop Relat Res"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s10195-026-00899-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00899-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00899-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:14:02Z","timestamp":1770898442000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s10195-026-00899-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["899"],"URL":"https:\/\/doi.org\/10.1186\/s10195-026-00899-6","relation":{},"ISSN":["1590-9999"],"issn-type":[{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"assertion":[{"value":"28 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of orthopedic department of Cairo University. Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests. The authors have no relevant financial or non-financial interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"5"}}