Severe slipped capital femoral epiphysis presents a difficult balance between correcting deformity and avoiding complications such as femoral-head avascular necrosis. This systematic review and meta-analysis compared the modified Dunn procedure with in-situ fixation in moderate and severe SCFE. The modified Dunn approach produced better radiographic correction, including improved Southwick and alpha angles, but did not demonstrate a clear clinical outcome advantage. Importantly, the pooled evidence did not show a meaningful difference in the odds of avascular necrosis or chondrolysis, although the evidence base was small and heterogeneous. The study therefore challenges the assumption that superior anatomical correction automatically results in superior patient-reported function. The authors emphasised that, when modified Dunn is used, it should be concentrated in high-volume centres with appropriate expertise because of the technical demands of the procedure. For clinicians, the practical message is to distinguish the goals of deformity correction from the goals of safe, durable function. In a severe or unstable slip, referral to an experienced paediatric hip surgeon may be more important than choosing a particular technique in isolation. The paper supports careful case selection and honest discussion of both radiographic and clinical uncertainty.