A COMPREHENSIVE PELVIC AND FEMORAL OSTEOTOMY REVISION TO TREAT A FAILED PELVIC AND FEMORAL OSTEOTOMY: A CASE REPORT

2021 ◽  
pp. 2150022
Author(s):  
Panos K. Megremis ◽  
Orestis P. Megremis
Keyword(s):  
Surgical Procedure ◽  
Open Reduction ◽  
Pelvic Osteotomy ◽  
Femoral Osteotomy ◽  
Salter Osteotomy ◽  
Shortening Osteotomy ◽  
Innominate Osteotomy ◽  
Walking Age ◽  
One Year

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent. The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.

Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

2017 ◽  
Vol 28 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Olivier Rosello ◽  
Federico Solla ◽  
Ioana Oborocianu ◽  
Edouard Chau ◽  
Tony ElHayek ◽  
...  
Keyword(s):  
Pelvic Osteotomy ◽  
Wilcoxon Test ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Salter Osteotomy ◽  
Stulberg Classification ◽  
And Performance ◽  
And Function ◽  
Chiari Osteotomy

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD. Methods: 29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test. Results: Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle. Conclusions: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

scholarly journals EVALUATION OF AVASCULAR NECROSIS DURING MIDTERM FOLLOW UP IN DDH CASES TREATED BY SINGLE STAGE SURGERY IN THE WALKING AGE GROUP

2021 ◽  
pp. 6005-6010
Keyword(s):  
Femoral Head ◽  
Surgical Procedures ◽  
Open Reduction ◽  
Soft Tissues ◽  
Developmental Dysplasia ◽  
Single Stage ◽  
Age Group ◽  
Developmental Dysplasia Of Hip ◽  
Walking Age

Developmental dysplasia of hip (DDH) represents a spectrum of disorders in which the femoral head has an abnormal relationship to the acetabulum. Management of DDH presenting in walking stage are primarily surgical because of changes in femoral head, acetabulum and soft tissues around joint. We looked at the incidence of AVN during midterm follow up period in DDH patients in the walking age group who had undergone single stage surgery. Also it evaluates association of different variables with occurrence of AVN. The AVN of head of femur is assessed according to Kalamchi and MacEwen’s classification and AVN gradings were compared with different surgical procedures. In our study, higher incidence of AVN was seen patients who were operated at a higher age, who had higher preoperative Tonnis grading and those who required osteotomies with open reduction. But statistically significant correlation could not be established independently with any of the above mentioned variables.

scholarly journals Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

2016 ◽  
Vol 2 (4) ◽  
pp. 256
Author(s):  
B. L. S. Kumar Babu ◽  
Biju Ravindran
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
High Energy ◽  
Walking Distance ◽  
Early Weight Bearing ◽  
Dual Plating ◽  
Pubic Diastasis ◽  
One Year

<p class="abstract"><strong>Background:</strong> Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.</p><p class="abstract"><strong>Methods:</strong> In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.</p><p><strong>Conclusions:</strong> Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.</p>

scholarly journals Outcome of Closed Reduction of Developmental Dysplasia of Hip Before First Year of Age, A Retrospective Cohort Study, Saudi Arabia

2020 ◽  
Author(s):  
Fahad AlShayhan ◽  
Abdulmonem Alsiddiky ◽  
Raghad Barri
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Medical Center ◽  
Developmental Dysplasia ◽  
First Year ◽  
Developmental Dysplasia Of Hip ◽  
Class 1 ◽  
One Year ◽  
Skin Traction

Abstract Background: Developmental dysplasia of hip (DDH) management is challenging hence there is no fixed rules or radiographic criteria to assess and manage DDH. There are many treating modalities including closed reduction, open reduction, skin traction, hip Spica and many others. This study is to assess the outcome of closed reduction in patients below 12 months of ages.Method: A retrospective study among patients with DDH who underwent closed reduction before the first year of age in a major referral medical center. The study included 100 patients and 168 hips. Average of follow up period was 5.97 years (±3.01). Couple of variables were measured in AP x ray of pelvis to assess the outcome of closed reduction. Results: Most of the hips were grade 1 and 2 according to the IHDI (International hip dysplasia institution) classification. Significant improvement in the acetabular index post closed reduction. In addition to the normalizing of CE angel's values. Also, majority of hips were severin's class 1 and 2 which were associated with good outcome.Conclusion: Safe closed reduction in patients with DDH below one year of age had a great outcome, less AVN, less growth complications and decrease the need of future open reduction.

scholarly journals Dega pelvic osteotomy: indications, results and complications

2018 ◽  
Vol 12 (4) ◽  
pp. 342-348 ◽  
Author(s):  
J. Czubak ◽  
K. Kowalik ◽  
A. Kawalec ◽  
M. Kwiatkowska
Keyword(s):  
Femoral Head ◽  
Open Reduction ◽  
Age Groups ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

scholarly journals Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip

2018 ◽  
Vol 12 (4) ◽  
pp. 364-368 ◽  
Author(s):  
S. R. Y. W. Thomas
Keyword(s):  
Femoral Head ◽  
Open Reduction ◽  
Skeletal Maturity ◽  
Hip Dislocation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Femoral Head Osteonecrosis ◽  
Salter Osteotomy ◽  
Innominate Osteotomy

IntroductionOnly a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction.SummaryComparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned.ConclusionsThere are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.

scholarly journals A Rare Case of an Irreducible Patella Dislocation

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Dimitri E. Delagrammaticas ◽  
Scott D. Cordes
Keyword(s):  
Open Reduction ◽  
Rare Case ◽  
Patella Dislocation ◽  
Chondral Defect ◽  
Lateral Patella ◽  
Initial Imaging ◽  
One Year ◽  
Nondisplaced Fracture ◽  
High Index Of Suspicion

Reports of irreducible patellar dislocations are exceedingly sparse throughout the literature. Obvious radiographic or physical exam findings including fracture or inversion of the patella are often present to explain the block to reduction. Not described previously in the literature is the instance of an irreducible patella dislocation in the setting of innocuous appearing injury imaging. We present a case of a healthy thirty-two-year-old female who sustained an irreducible lateral patella dislocation while participating in a dance aerobics class. Closed means of reduction were unsuccessful, necessitating open reduction. Intraoperative findings suggest incarceration of a nondisplaced fracture and a chondral defect as the block to reduction. Following open reduction, the patient has had no further episodes of pain or instability related to the patella at one-year follow-up. Irreducible patellar dislocations are exceedingly rare injuries, where associated osseous or chondral lesions may necessitate open reduction despite innocuous appearing initial imaging. A high index of suspicion to proceed with open reduction may limit repeated attempts at closed reduction and further injury.

scholarly journals Successful Treatment of a 15-Year-Old Nonunion of a Midshaft Clavicle Fracture Causing Brachial Plexus Compression

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Annemarijn Teunis ◽  
Rianne M. H. A. Huis In ’t Veld ◽  
Vincent E. J. A. de Windt ◽  
Sjoerd van Raak ◽  
Anne J. H. Vochteloo
Keyword(s):  
Brachial Plexus ◽  
Successful Treatment ◽  
Open Reduction ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
One Year ◽  
Internal Plate Fixation

A 49-year-old man with a 15-year-old nonunion of a midshaft clavicle fracture suffered from progressive tingling in his entire arm and fingers for two years, due to irritation of the brachial plexus in the costoclavicular space, especially upon elevation of the arm. After open reduction and internal plate fixation, all symptoms were resolved and complete consolidation of the fracture was achieved at one-year follow-up. This case demonstrates two things: brachial plexus compression can occur even many years after a nonunion of a clavicle fracture and union can be still achieved, even in a longstanding nonunion.

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