scholarly journals Relative overgrowth of the greater trochanter and trochanteric-pelvic impingement syndrome in children: causes and X-ray anatomical characteristics

2019 ◽  
Vol 7 (3) ◽  
pp. 15-24
Author(s):  
Ivan Y. Pozdnikin ◽  
Vladimir E. Baskov ◽  
Dmitry B. Barsukov ◽  
Pavel I. Bortulev ◽  
Andrey I. Krasnov
Keyword(s):  
Hip Joint ◽  
Hip Dislocation ◽  
Preschool Age ◽  
Greater Trochanter ◽  
X Ray ◽  
High Position ◽  
Anatomical Changes ◽  
Joint Pathology ◽  
Developmental Hip Dislocation ◽  
Survey Results

Background. The formation of multiplanar deformities of the proximal femur, in most cases combined with hypertrophy of the greater trochanter (relative overgrowth of the greater trochanter (ROGT)) and its high position relative to the femoral head, up to the development of pelvic and pelvic spine syndrome (trochanteric-pelvic impingement), has been considered one of the most common problems in the treatment of children with hip joint pathology of various etiologies. Aim. The aim of this study was to determine the causes of and characterize the X-ray anatomical changes in children with ROGT. Materials and methods. This study is based on an analysis of the survey results of 350 children 3 to 17 years old with an emerging high position of the greater trochanter due to various diseases of the hip joint. Details of the radiological indicators characterizing the change in the growth of the greater trochanter relative to the head and neck of the thigh were examined in 68 of these children (112 joints). Results. Most often, hypertrophy of the greater trochanter was observed in children with the sequele of ischemic disorders that occurred during the conservative treatment of hip dysplasia and developmental hip dislocation, as well as due to previous hematogenous osteomyelitis. It was revealed that in the affected hip joints, there was a regular decrease in the articulo-trochanteric distance index; simultaneously, TTD values, which characterize the isolated growth of the greater trochanter, were almost the same in normal and pathological conditions (p 0.05). Conclusion. Damage to the growth plates of the pineal gland and neck of the femur of various etiologies was the reason for ROGT formation. The X-ray anatomical changes include progressive shortening of the femoral neck. Moderately pronounced in preschool-age children, they progress with the childs growth and become the cause of chronic trauma injuries of the components of the hip joint.

scholarly journals Nonunion of the bone fragments during total hip replacement with T. Paavilainen osteotomy — causes of failure

2020 ◽  
Vol 8 (2) ◽  
pp. 119-128
Author(s):  
Alexandr I. Avdeev ◽  
Igor A. Voronkevich ◽  
Dmitrii G. Parfeev ◽  
Anton N. Kovalenko ◽  
David G. Pliev ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Greater Trochanter ◽  
Total Hip ◽  
Shortening Osteotomy ◽  
History Of ◽  
Bone Fragments

Background. Conservative treatment options for hip dysplasia and hip dislocation in early childhood allow for good results in cases of a timely diagnosis. The preferred treatment option for patients with hip dislocation in adulthood is total hip joint replacement. The shortening osteotomy, proposed by T. Paavilainen, allows the surgeon to restore the difference in the lengths of the lower extremities during arthroplasty of the hip joint. However, according to the results of the Paavilainen technique, as presented by Russian orthopedic surgeons, the problem of nonunion of the greater trochanter fragment with the diaphysis of the femur remains unresolved, as evidenced by a massive group of clinical cases. Aim. The aim of this study was to identify factors affecting the consolidation of bone fragments after osteotomy of the greater trochanter, according to T. Paavilainen, during total hip arthroplasty and evaluate their significance after fixation with cerclage screws in comparison with a special trochanteric fork-plate. Materials and methods. The present study includes 208 cases that were treated at the Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden from 2003 to 2019 using various fixation techniques of the greater trochanter fragment. Patients were divided into two groups depending on their type of fixation. The quality of consolidation of a greater trochanter fragment with the femur was assessed during a follow-up period of six months or longer. The fragment of the greater trochanter was divided into the part that was not in contact with the diaphysis, or A, and the part that was in contact with the diaphysis, or B. We assessed the effect of the absolute value of the contact between fragments, the B/A ratio, the distance between the points of insertion of the screws into the diaphyseal part of the femur, the quality of the bone by the modified Barnet-Nordin index, and the history of previous surgical interventions on this joint on the consolidation. Results. When the part of the greater trochanter was in contact with the diaphysis of the femur (B) was less than 3.5 cm, the risk ratio of nonunion of the greater trochanter fragment with the diaphysis of the femur increased. Also, a significant factor is the index of the contact of the greater trochanter fragment (B/A less than 1) with the diaphysis of the femur using the T. Paavilainen technique. In addition, the presence of surgical intervention in the hip joint history significantly increases the relative risk (RR) of nonunion of the greater trochanter fragment with the diaphysis of the femur with this method of shortening osteotomy of the femur. Conclusion. In the absence of timely diagnosis and conservative treatment of children with hip dislocation, reconstructive-plastic techniques on the hip joint do not allow the achievement of proper results and increase the complexity of total hip arthroplasty. According to the results of this study, the absolute value of the contact between fragments (B), the index of the greater trochanter contact with the diaphysis of the femur, and the history of previous surgical intervention on this joint are objective tools for the prognostic assessment of the probability of fragment unions during total hip arthroplasty with the T. Paavilainen technique.

scholarly journals Transposition of the great trochanter: A look at the problem

2021 ◽  
Vol 9 (2) ◽  
pp. 195-202
Author(s):  
Ivan Y. Pozdnikin ◽  
Pavel I. Bortulev ◽  
Dmitry B. Barsukov ◽  
Vladimir E. Baskov
Keyword(s):  
Surgical Treatment ◽  
Femoral Neck ◽  
Range Of Motion ◽  
Hip Joint ◽  
Proximal Femur ◽  
Great Trochanter ◽  
Clinical Parameters ◽  
Greater Trochanter ◽  
Hip Joints ◽  
High Position

BACKGROUND: Multiplanar deformity of the proximal femur with a high position of the greater trochanter is one of the most common residual deformities of the hip joint. The VeauLamy transposition of the greater trochanter does not fully treat the mutual trauma of the components of the hip joint, as it only brings down the greater trochanter to provide tension for the gluteal muscles. AIM: This study aimed to share the experience of performing transposition of the greater trochanter according to our proposed technique. MATERIALS AND METHODS: The study included 15 patients (15 hip joints) aged 916 years with a high position of the greater trochanter of the femur, who underwent surgical treatment in the period from 2018 to 2019. In addition to the actual transposition of the greater trochanter, the intervention provided a modeling resection of the base (bed) of the greater trochanter and the formation of an offset of the femoral neck. RESULTS: Patients were followed up for period of up to 30 months. All patients showed positive changes after surgical treatment with improvement of radiological and clinical parameters. CONCLUSIONS: The proposed intervention allows restoration of the function of the gluteal muscles, improves the range of motion in the hip joint, and prevents and treats extra-articular impingement syndrome.

scholarly journals Corrective Intertrochanteric Osteotomy of the Femur for Aseptic Necrosis of the Femoral Head after Bloodless Reduction of Congenital Dislocation in School-Age Children

2021 ◽  
Vol 07 (10) ◽  
Author(s):  
Khojaakhmed Shaykhislamovich Alpysbaev ◽  
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Hip Dislocation ◽  
School Age Children ◽  
Congenital Dislocation ◽  
School Age ◽  
Greater Trochanter ◽  
Congenital Hip Dislocation ◽  
Aseptic Necrosis ◽  
Results Of Treatment

The immediate results of treatment of 72 children aged 7 to 12 years with aseptic necrosis of the femoral head after bloodless reduction of congenital hip dislocation were analyzed. When treating patients, the following types of surgical treatment were used:extra-articular or open centering of the femoral head with intertrochanteric-torsion-varizing or devarizing and rotational osteotomy of the femur with bringing down the greater trochanter in the caudal direction. In all patients, pain and lameness disappeared, internal rotation of the lower extremities when walking, and the range of motion in the hip joint improved. Improved radiometric parameters characterizing the ratio of the acetabulum and the head of the femur and the angular values of the hip joint and proximal femur.

Greater Trochanteric Transfer in Children

1992 ◽  
Vol 2 (2) ◽  
pp. 47-52
Author(s):  
R. Guarniero ◽  
W.P. Bunnell ◽  
G.D. Macewen
Keyword(s):  
Hip Joint ◽  
Surgical Procedure ◽  
Clinical Findings ◽  
Joint Motion ◽  
Older Children ◽  
Greater Trochanter ◽  
X Ray ◽  
Lever Arm ◽  
Hip Abduction ◽  
Hip Abductor

Fifteen patients who were treated at the Alfred I. DuPont Institute with greater trochanter overgrowth were reviewed to investigate the results of a surgical procedure for greater trochanteric transfer. The aim of the paper is to present the clinical findings, X-Ray evaluation, pre and post-operative measurements based on pain, limp, Trendelemburg sign, hip abduction power and hip joint motion. The surgical procedure itself is relatively easy to perform and does not often result in complications. The greater trochanteric transfer is indicated for older children (about ten years of age) and can offer good results in patients who require elongation of the lever arm in hip abductor muscles.

scholarly journals Trochanteric epiphysiodesis in complex treatment of children with hip pathology: analysis of preliminary results

2020 ◽  
Vol 8 (3) ◽  
pp. 249-258
Author(s):  
Ivan Y. Pozdnikin ◽  
Vladimir E. Baskov ◽  
Dmitry B. Barsukov ◽  
Pavel I. Bortulev ◽  
Ekaterina A. Kostomarova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Joint ◽  
Complex Treatment ◽  
Greater Trochanter ◽  
Surgical Interventions ◽  
High Position ◽  
Neck Shaft Angle ◽  
Slowing Down ◽  
Shaft Angle ◽  
Radiological Examinations

Background. The relative overgrowth of the greater trochanter is one of the most common deformities of the proximal femur in association with several disorders of the hip joint. Aim. To analyze the dynamics of proximal femoral growth after trochanteric epiphysiodesis as well as to determine the options for using this method in the complex treatment of children with hip pathology. Materials and methods. We analyzed the data of clinical and radiological examinations and surgical treatment (permanent trochanteric epiphysiodesis with metal fixation) outcomes for 43 (52 joints) patients aged 412 years with a developing high position of the greater trochanter. Results. The surgery enabled slowing down of the growth of the greater trochanter on the side of intervention by (average) 50% (p 0.05), although the values of the neck-shaft angle both on the affected side and the side opposite to it did not change (p 0.05). Conclusion. In moderate disorders of the growth plate of the femoral head epiphysis, trochanteric epiphysiodesis can prevent the progression and, in some cases, correct disturbed ratios of the hip joint, thereby avoiding the need for larger surgical interventions.

scholarly journals Morphological consistency of bilateral hip joints in adults based on the X-ray and CT data

2021 ◽  
Author(s):  
Ran Zhao ◽  
Hong Cai ◽  
Hua Tian ◽  
Ke Zhang
Keyword(s):  
Hip Joint ◽  
Morphological Difference ◽  
Medullary Cavity ◽  
Size Difference ◽  
Single Plane ◽  
X Ray ◽  
Stem Size ◽  
The Difference ◽  
Ct Data ◽  
Anatomical Parameters

Abstract Purpose The application of the anatomical parameters of the contralateral hip joint to guide the preoperative template of the affected side relies on the bilateral hip symmetry. We investigated the bilateral hip symmetry and range of anatomical variations by measurement and comparison of bilateral hip anatomical parameters. Methods This study included 224 patients (448 hips) who were diagnosed with osteoarthritis (OA) and avascular necrosis (AVN) of the femur head, and underwent bilateral primary total hip arthroplasty (THA) in our hospital from January 2012 to August 2020. Imaging data included 224 patients X-ray and 30 CT data at the end of the cohort. Anatomical parameters, including the acetabular abduction angle and trochanteric height, were measured using the Noble method. Postoperative measurements included stem size, difference of leg length and offset. Results Except for the isthmus width, there were no significant differences in the anatomical morphology of the hip joint. Among the demographic factors, there was a correlation between body weight and NSA. Among various anatomical parameters, a correlation was present between medullary cavity widths of T + 20, T, and T − 20. The difference in the use of stem size is not due to the morphological difference of bilateral medullary cavity, but due to the different of 1- or 2-stage surgery. Conclusion Bilateral symmetry was present among the patients with normal morphology of the hip medullary cavity, theoretically confirming the feasibility of structural reconstruction of the hip joint using the hip joint on the uninjured side. Additionally, the difference in the morphology of the hip medullary cavity is not present in a single plane but is synergistically affected by multiple adjacent planes.

Anteroinferior dislocation of the hip joint associated to a fracture of the greater trochanter

2021 ◽  
Vol 25 ◽  
pp. 101115
Author(s):  
Fekhaoui Mohammed Reda ◽  
Bakayan Mohammed Said ◽  
Boussouga Mostapha
Keyword(s):  
Hip Joint ◽  
Greater Trochanter ◽  
Dislocation Of The Hip

scholarly journals Traumatic Obturator Dislocation of the Hip Joint Associated with Greater Trochanter Fracture: A Case Report

2021 ◽  
Author(s):  
Qifeng Tao ◽  
Fenglin Zhong ◽  
Chuan Wang ◽  
Hongping Wang ◽  
Chunyu Chen ◽  
...  
Keyword(s):  
Case Report ◽  
Hip Joint ◽  
Greater Trochanter ◽  
Trochanter Fracture ◽  
Dislocation Of The Hip

Rapid prototyping for orthopaedic surgery

1998 ◽  
Vol 212 (5) ◽  
pp. 383-393 ◽  
Author(s):  
P Potamianos ◽  
A A Amis ◽  
A J Forester ◽  
M McGurk ◽  
M Bircher
Keyword(s):  
Computed Tomography ◽  
Rapid Prototyping ◽  
Orthopaedic Surgery ◽  
Three Dimensional ◽  
Clear Understanding ◽  
Shoulder Injury ◽  
Physical Relationship ◽  
X Ray ◽  
Joint Pathology ◽  
X Ray Computed

The revision of an orthopaedic procedure can present surgeons with the challenge of a complex reconstructive process. Orthopaedic surgery can also face considerable challenges in cases presenting extensive primary injuries with multiple bone fragmentation, as well as in cases presenting bone deformities. Radiographs are used routinely for orthopaedic surgical planning, yet they provide inadequate information on the precise three-dimensional extent of bone defects. Three-dimensional reconstructions from X-ray computed tomography offer superior visualization but are not portable for consultation or readily available in the operating theatre for guidance during a procedure. A physical model manufactured from X-ray computed tomography data can offer surgeons a clear understanding of complex anatomical detail, by providing an intuitive physical relationship between patient and model. Rapid prototyping was used for the construction of an anatomical model in a case presenting with a complex shoulder injury. The model provided a definitive interpretation of joint pathology and enabled a full assessment of the degree of injury.

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