scholarly journals A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis

2020 ◽  
Vol 14 (5) ◽  
pp. 379-386
Author(s):  
Arash Ghaffari ◽  
Søren Kold ◽  
Ole Rahbek
Keyword(s):  
Femoral Neck ◽  
Slipped Capital Femoral Epiphysis ◽  
Young Patients ◽  
Limb Length Discrepancy ◽  
Level Of Evidence ◽  
Developmental Hip Dysplasia ◽  
Online Databases ◽  
Lengthening Osteotomy ◽  
The Mean ◽  
Meta Analyses

Purpose Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening. Methods After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported. Conclusions Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips. Level of evidence III

scholarly journals Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach

2020 ◽  
Vol 14 (3) ◽  
pp. 190-200 ◽  
Author(s):  
Mostafa M. Baraka ◽  
Hany M. Hefny ◽  
Mootaz F. Thakeb ◽  
Tamer A. Fayyad ◽  
Haytham Abdelazim ◽  
...  
Keyword(s):  
Slipped Capital Femoral Epiphysis ◽  
Alpha Angle ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Functional Score ◽  
Surgical Hip Dislocation ◽  
Level Of Evidence ◽  
Surgical Dislocation ◽  
Imhauser Osteotomy ◽  
The Mean

Purpose Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence IV

scholarly journals Limb lengthening in the treatment of posteromedial bowing of the tibia

2020 ◽  
Vol 14 (5) ◽  
pp. 480-487
Author(s):  
J. Eric Gordon ◽  
Perry L. Schoenecker ◽  
Thomas R. Lewis ◽  
Mark L. Miller
Keyword(s):  
Skeletal Maturity ◽  
Deformity Correction ◽  
Limb Lengthening ◽  
Limb Length Discrepancy ◽  
Single Institution ◽  
Level Of Evidence ◽  
Tibial Lengthening ◽  
The Mean ◽  
Ankle Valgus

Purpose Posteromedial bowing of the tibia is an uncommon but recognized congenital lower extremity deformity in children that can lead to limb length discrepancy (LLD) and residual angulatory deformity. The purpose of this study is to report a series of children at a single institution with posteromedial bowing treated by lengthening. Methods A retrospective review was carried out at our institution identifying 16 patients who were treated with limb lengthening for posteromedial bowing of the tibia and followed to skeletal maturity. Projected LLD was a mean of 7.7 cm (range 5.0 cm to 14.2 cm). Three patients were treated in a staged fashion with lengthening and deformity correction at age three to four years and subsequent definitive tibial lengthening. The remaining 13 patients were treated with limb lengthening approaching adolescence using circular external fixation. Results All patients were pain free and ambulated without a limp at final follow-up. The mean final LLD was 0.3 cm short. In spite of correction of distal tibial shaft valgus in 11 of the 16 patients, eight of the 16 (50%) required later correction of persistent, symptomatic ankle valgus by either hemiepiphyseodesis (seven patients) or osteotomy (one patient). Conclusions Children with posteromedial bowing of the tibial with projected LLD over 5cm can be effectively treated with lengthening. Patients with severe valgus of more than 30° of shaft valgus and difficulty ambulating at age three years can be successfully treated with a two-stage lengthening procedure. Attention should be paid in patients with posteromedial bowing to ankle valgus. Level of Evidence IV

scholarly journals Valgus Osteotomy Outcome for Treating Femoral Neck Nonunion in Young and Active Patients

2021 ◽  
Vol 8 (2) ◽  
pp. 65-70
Author(s):  
Kaveh Gharanizadeh ◽  
◽  
Hamed Tayyebi ◽  
Abbas Esmaeli ◽  
Maziar Rajei ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Osteotomy Site ◽  
Valgus Osteotomy ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
The Mean

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles. Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study‎. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the ‏osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore‎, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients‎.

scholarly journals Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093782
Author(s):  
Youheng Ou Yang ◽  
Chloe Xiaoyun Chan ◽  
Gloria Hui Min Cheng ◽  
Sumanth Kumar Gera ◽  
Arjandas Mahadev ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Slipped Capital Femoral Epiphysis ◽  
Operator Coefficient ◽  
Number Needed To Treat ◽  
Level Of Evidence ◽  
Treatment Threshold ◽  
Treatment Thresholds ◽  
The Mean ◽  
Femoral Physis

Background: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater than 12–14.5° has been proposed by various authors as a treatment threshold to predict for contralateral hip progression and prophylactic pinning. Methods: A retrospective review of a 10-year series of patients with the diagnosis of SCFE and follow-up of 18 months was conducted. Patients were divided into two groups, those with Isolated Unilateral Slips and those who subsequently underwent Subsequent Contralateral Progression. PSA measurements were performed by two clinicians and assessed for inter-observer reliability. Data collected included age, sex, ethnicity, Loder class, endocrinopathy, renal impairment, radiation exposure, and PSA. Results: There were no significant differences between the distribution of gender, site of slip, age of onset, Loder class, and presence of medical comorbidities between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups ( p > 0.05). The mean PSA value was not significantly higher in the Subsequent Contralateral Progression group (17.9 ± 4.32 (10.5–23.5)) compared to the Isolated Unilateral Slip group (15.8 ± 5.31 (6–26)) ( p = 0.32). The receiver operator coefficient-derived ideal treatment threshold of 16.5° gave a sensitivity of 0.71, specificity of 0.64, and number needed to treat of 3. Conclusion: PSA differences between the Subsequent Contralateral Progression and Isolated Unilateral Slip groups were not statistically significant in this series. All proposed treatment thresholds had poor specificity. Prophylactic pinning should not be based on isolated PSA values. Level of evidence: III.

Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle

2018 ◽  
Vol 39 (5) ◽  
pp. 522-529 ◽  
Author(s):  
Florian Gaul ◽  
Luís E. P. Tírico ◽  
Julie C. McCauley ◽  
William D. Bugbee
Keyword(s):  
Young Patients ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Time To Failure ◽  
Level Of Evidence ◽  
Proper Patient Selection ◽  
Long Term Follow Up ◽  
The Mean ◽  
Mean Time

Background: Osteochondral allograft (OCA) transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a relatively high failure rate and further procedures are often required. The purpose of this study was to evaluate outcomes of patients who underwent revision OCA transplantation of the ankle after failed primary OCA transplantation. Methods: Twenty patients underwent revision OCA transplantation of the ankle between 1988 and 2015. Mean age was 44 years, 55% (11 of 20) were female. The mean time from primary to revision OCA was 3.0 ± 1.7 years. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM) and questionnaires evaluating pain and satisfaction. Failure of the revision OCA was defined as a conversion to arthroplasty, arthrodesis, or amputation. Results: Ten of 20 ankles required further surgery, of which 30% (6 of 20) were considered OCA revision failures (4 arthrodeses, 1 arthroplasty, and 1 amputation). The mean time to failure was 6.7 (range, 0.6-13.1) years. Survivorship of the revision OCA was 84% at 5 years and 65% at 10 years. The 14 patients with grafts remaining in situ had an average follow-up of 10.3 years; mean AAOS-FAM Core Score was 70.5 (range, 42.3-99). Of the patients who answered the follow-up questions, 4 of 7 reported moderate to severe pain, and 5 of 12 were satisfied with the results of the procedure. Conclusion: Although the results of revision ankle OCA transplantation are not inferior to primary OCA transplantation, the high rates of persistent pain, further surgery, and graft failure suggest that the indications for OCA as a revision procedure should be carefully evaluated, with proper patient selection. Considering the treatment alternatives, revising a failed OCA transplantation can be a useful treatment option, especially for young and active patients who wish to avoid arthrodesis or arthroplasty. Level of Evidence: Level IV, case series.

scholarly journals Surgical Treatment Outcome in Young Adults With Femoral Neck Fractures

2020 ◽  
Vol 7 (1) ◽  
pp. 23-28
Author(s):  
Karim Pisoudeh ◽  
◽  
Kaveh Gharanizadeh ◽  
Mohammad Reza Sarshar ◽  
Mani Mahmoudi ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Analytical Study ◽  
Young Patients ◽  
Neck Surgery ◽  
High Energy ◽  
Anatomic Reduction ◽  
Neck Fracture ◽  
The Mean ◽  
Type Of Fracture

Background: Femoral Neck Fracture (FNF) is prevalent in young people. It is mostly due to high-energy trauma and creates many challenges in surgical repair. A few patients with hip fractures can fully recover from the injury and act independently in their daily activities. In this study, we evaluated the results of FNF operation in patients younger than 60 years.  Objectives: This study was conducted to evaluate the outcome of femoral neck surgery in young patients and comparison the complications according to types of surgery ,age,delay and type of FNF fracture.  Methods: This study was a retrospective-prospective descriptive and analytical study on patients 15 to 60 years old with FNF from 2013 to 2017. The surgical efficacy and its results were evaluated using the Harris Hip Scale (HHS). The obtained data were analyzed in SPSS version V. 24.  Results: The Mean±SD age of 53 study patients was 42.07±12.5 years. The Mean±SD femoral neck shortening was 7.05±5.42 mm, and the HHS score was 82.7±6.9. Avascular Necrosis (AVN) was seen in 10 (18.9%), malunion in 11 (20.8%), nonunion in 1 (1.9%)  and failure in 3 (5.7%) patients. Eight patients had reoperation procedures. The type of fracture, delay in surgery, type of operation, and the shortening of the femoral neck were predictive factors of postoperative complications (P<0.05).  Conclusion: According to this study, reducing the delay for surgery, increasing anatomic reduction, and preventing the shortening of the femoral neck can improve the quality of life, reduce complications, and decrease the economic burden. 

Consultation with the Specialist

1996 ◽  
Vol 17 (2) ◽  
pp. 69-70
Author(s):  
B. Stephens Richards
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Growth Plate ◽  
Clinical Presentation ◽  
Slipped Capital Femoral Epiphysis ◽  
Normal Growth ◽  
Stable Relationship ◽  
Shear Type ◽  
The Mean ◽  
American Children

Slipped capital femoral epiphysis is the most common orthopedic hip disorder occurring in adolescence. In this condition, the femoral head (epiphysis) displaces, or slips, on the femoral neck through the region of the growth plate. This may result from traumatic forces acting on a normal growth plate (physis) or from ordinary forces acting on a weakened growth plate. In the latter situation, resistance to shear-type forces within the physis is decreased. This leads to the growth plate giving way when exposed to modest forces, such as running, skipping, or twisting. The femoral head may displace abruptly, analogous to a fracture, and may be exquisitely painful to the patient. Or, the femoral head may displace gradually, maintaining a stable relationship between it and the femoral neck, and may present clinically only as an ache in the groin. Regardless of the clinical presentation, the proper management requires urgent surgical intervention in an effort to avoid further displacement. Thus, early diagnosis is of utmost importance in the management of slipped capital femoral epiphysis. Epidemiology The general incidence of this condition is 1 to 3 per 100 000, with a slightly higher incidence in African-American children. Males are affected twice as often as females. The children are obese (the weight being 2 standard deviations above the mean for the child's age) in 67% of cases.

scholarly journals Evaluation of femoral neck shaft angle on plain radiographs and its clinical implications

2016 ◽  
Vol 2 (4) ◽  
pp. 383 ◽  
Author(s):  
Subodh Kumar Pathak ◽  
Pritam Maheshwari ◽  
Prahlad Ughareja ◽  
Daksh Gadi ◽  
Prashanth Raj M. ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Indian Subcontinent ◽  
Slipped Capital Femoral Epiphysis ◽  
Orthopedic Implants ◽  
Developmental Dysplasia ◽  
Neck Of Femur ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
The Mean ◽  
Picture Archiving And Communication

<p class="abstract"><strong>Background:</strong> The femoral neck-shaft angle is the measurement of the angle formed between the oblique oriented neck with the vertical shaft and is an important anatomic measurement for the evaluation of biomechanics of hip.<span> The neck shaft angle is important in surgeries that involve the neck of femur, Intertrochanteric fractures, slipped capital femoral epiphysis, and developmental dysplasia of hip. Different variation of neck shaft angle has been seen in different literature and all the orthopedic implants are designed according to the values of the western literature which is different from the Indian subcontinent</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span>Pelvic radiographs of patients who presented to Accident and emergency care or the outpatient department were used in the study</span> 110 patients radiographs were assessed in the study. There were 55 males and 55 females in our study. The mean age for males was 46.5 years and that for females was 43.2 years. The pelvis radiographs were studied for neck shaft angle .The measurements were performed bilaterally on the digital screen using the PACS (picture archiving and communication system) with handheld 360 degree goniometer.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean neck shaft angle in our study was129.26 degree for males and 126.62 degree for females .The overall mean neck shaft angle in 110 radiographs was 128.60 degree<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that consideration of neck shaft angles in orthopedics surgery and designing of implant can give more angle options for the surgeons which can improve the overall prognosis of the patient.</span></p>

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Sign in / Sign up

Export Citation Format

Share Document