scholarly journals Clinical efficacy of early open reduction of dislocated hips using a modified Smith-Peterson approach in arthrogyposis multiplex congenita

2020 ◽  
Author(s):  
Mingyuan Miao ◽  
Haiqing Cai ◽  
Zhigang Wang ◽  
Liwei Hu ◽  
Jingxia Bian ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Open Reduction ◽  
Linear Regression Analysis ◽  
Randomized Study ◽  
Hip Dislocation ◽  
Rectus Femoris ◽  
Pelvic Osteotomy ◽  
Multiple Linear Regression Analysis ◽  
Arthrogryposis Multiplex Congenita ◽  
Level Of Evidence

Abstract Background: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. There is controversy regarding what the best surgical approach and age is for performing reduction of dislocated hips in AMC. The purpose of this retrospective study was to evaluate the clinical outcome of early open reduction on infant hip dislocation with arthrogryposis multiplex congenita through the modified Smith-Peterson approach, with retained rectus femoris intact. Methods: From 2010 to 2017, we performed this procedure on 28 dislocated hips in 20 infants under 12 months of age with AMC. The clinical and radiology data were retrospectively reviewed. The mean age at surgery was 6.9 ± 5.1 months, with a mean follow-up of 42.4 ± 41.1 months. Results: After open reduction, the average hip acetabular index (AI), the international hip dysplasia institute classification (IHDI), and hip range of motion were significantly improved (all P<0.001). After the surgery, 16 patients were community walkers and four patients were home walkers. Three hips in two patients required secondary revision surgery for residual acetabular dysplasia with combined pelvic osteotomy and femoral osteotomy. Seven of the hips that had been operated on showed signs of avascular necrosis (AVN). Among them, four were degree II, two were degree III, and one was degree IV. Multiple linear regression analysis demonstrated that the older months are risk factors for secondary revision surgery (P=0.032). Conclusions: The modified Smith-Peterson approach with retained rectus femoris intact is an encouraging and safe option for treating hip dislocation in young AMC patients (before 12 months). Even if surgery takes place at less than 12 months old for patients with AMC, earlier open reduction for hip dislocation may reduce the chance of secondary revision surgery. Level of Evidence: IV, retrospective non-randomized study. Key words: Arthrogryposis, Hip dislocation, Open reduction, Modified Smith-Peterson approach, Retained rectus femoris

scholarly journals Early open reduction of dislocated hips using a modified Smith-Petersen approach in arthrogyposis multiplex congenita

2020 ◽  
Author(s):  
Mingyuan Miao ◽  
Haiqing Cai ◽  
Zhigang Wang ◽  
Liwei Hu ◽  
Jingxia Bian ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Open Reduction ◽  
Linear Regression Analysis ◽  
Hip Dislocation ◽  
Rectus Femoris ◽  
Pelvic Osteotomy ◽  
Multiple Linear Regression Analysis ◽  
Medical Community ◽  
Arthrogryposis Multiplex Congenita ◽  
Age At Surgery

Abstract Background: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. Within the medical community, there is controversy surrounding AMC in terms of the ideal surgical approach and age for performing a reduction of dislocated hips. The purpose of this retrospective study was to evaluate the clinical outcomes of early open reduction of infant hip dislocation with arthrogryposis multiplex congenita following a modified Smith-Petersen approach that preserves the rectus femoris. Methods: From 2010 to 2017, we performed this procedure on 28 dislocated hips in 20 infants under 12 months of age with AMC. The clinical and radiology data were reviewed retrospectively. The mean age at surgery was 6.9 ± 5.1 months, with a mean follow-up of 42.4 ± 41.1 months. Results: After open reduction, the average hip acetabular index (AI), the international hip dysplasia institute classification (IHDI), and the hip range of motion significantly improved (all P<0.001). After the surgery, 16 patients were community walkers, and four patients were home walkers. Three hips in two patients required secondary revision surgery for residual acetabular dysplasia with combined pelvic osteotomy and femoral osteotomy. Seven of the hips that had been operated on showed signs of avascular necrosis (AVN). Among them, four were degree II, two were degree III, and one was degree IV. Multiple linear regression analysis demonstrated that greater age (in months) heightened the risk for secondary revision surgery (P=0.032). Conclusions: The modified Smith-Petersen approach preserving the rectus femoris is an encouraging and safe option for treating hip dislocation in young AMC patients (before 12 months). If surgery takes place at less than 12 months of age for patients with AMC, this earlier open reduction for hip dislocation may reduce the chances of secondary revision surgery.

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

2016 ◽  
Vol 41 (8) ◽  
pp. 793-801 ◽  
Author(s):  
I. Z. Rigo ◽  
M. Røkkum
Keyword(s):  
Flexor Tendon ◽  
Linear Regression Analysis ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Multiple Linear Regression Analysis ◽  
Level Of Evidence ◽  
Pulley System ◽  
Skeletal Injury ◽  
Active Mobilization

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3–98), respectively. Using the Strickland criteria, ‘excellent’ or ‘good’ function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath–pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert’s regime. Level of evidence: III

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 Effect of Opioid Limiting Legislation on Postoperative Opioid Utilization in Patients Treated for Ankle Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142093950
Author(s):  
Connor G. Hoge ◽  
Robert N. Matar ◽  
Colin D. F. Cotton ◽  
Michael G. Rubeiz ◽  
Tonya L. Dixon ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Postoperative Period ◽  
Injury Severity ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Ankle Fractures ◽  
Level Of Evidence ◽  
The Mean

Background: The state of Ohio implemented legislation in August of 2017 limiting the quantity of opioids a provider could prescribe. The purpose of this study was to identify if implementation of legislation affected opioid and nonopioid utilization in patients operatively treated for ankle fractures in the initial 90-day postoperative period after controlling for injury severity and preoperative narcotic usage. Methods: A retrospective review of 144 patients treated for isolated ankle fractures in a pre-law group (January 2017–July 2017; n = 73) and post-law group (January 2018–July 2018; n = 71) was completed using electronic medical records and a legal prescriber database. Total number of opioid prescriptions, pills, milligrams of morphine equivalents (MMEs), and nonopioid prescriptions were recorded. Multiple regression analysis was run to identify predictors of opioid prescribing after controlling for law group, demographic, preoperative narcotic use, and injury severity characteristics. Results: Mean MME prescribed per patient significantly decreased from 817.2 MME pre-law to 380.9 post-law ( P < .01). Mean number of opioid pills prescribed per patient decreased from 99.1 in the pre-law group and 55.3 in the post law group ( P < .001), respectively. Multiple linear regression analysis to predict the mean number of opioid pills prescribed was statistically significant ( R 2 = 0.33; P < .001), with law group adding significantly to the prediction ( P < .001). The multiple linear regression analysis to predict MME per patient was found to be statistically significant ( R 2 = 0.31; P < .001), with the law group contributing significantly ( P < .001). Conclusion: The Ohio prescriber law successfully contributed to the decreased number of opioid pills and MME prescribed in the initial 90-day postoperative period after controlling for injury severity and preoperative narcotic usage. Policies on opioid prescriptions may serve as an important public health tool in the fight against the opioid epidemic. Level of Evidence: Level III, retrospective comparative series.

scholarly journals PEDIATRIC FLEXIBLE VALGUS FLATFOOT CORRECTION BY ARTHROEREISIS

2020 ◽  
Vol 28 (5) ◽  
pp. 212-215
Author(s):  
CÍNTIA KELLY BITTAR ◽  
ALBERTO CLIQUET JÚNIOR ◽  
ALEXANDRA MAURIEL DOS REIS ◽  
BRUNA MADELEINE DA SILVA SIMPLÍCIO FLÔR ◽  
DÉBORA PENNA CHAVES BERTAZZO ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Valgus Deformity ◽  
Level Of Evidence ◽  
Radiographic Images ◽  
Clinical Evaluations ◽  
Selection Of Variables ◽  
Flexible Flatfoot ◽  
American Orthopaedic

ABSTRACT Objective: This article aimed to evaluate the efficacy of arthroereisis using synthetic polyethylene implants to correct excessive valgus deformity in pediatric patients with flexible valgus flatfoot. Methods: Retrospective study of 20 pediatric patients with flexible valgus flatfoot, totaling 23 feet, between five and 14 years old, operated between January 2009 and July 2016. Clinical evaluations were performed by the Valenti podoscopic classification and the American Orthopaedic Foot & Ankle Society criteria, based on radiographic images and podoscopic analysis. These patients underwent surgical treatment with the introduction of a synthetic implant in the sinus tarsi. Multiple linear regression analysis with Backward selection of variables, angles of pre and postoperative of radiographic images of the patients submitted to arthroereisis were performed. Results: The arthroereisis with interposition of synthetic material was satisfactory, considering that 91% of the cases presented clinical and radiographic improvement, with correction of angles and improvement in deformity degrees. Two cases presented implant loosening. The variables of the Bordelon and Pitch angles significantly influenced (p < 0,05) the improvement of the correction of deformity degrees. Conclusion: The arthroereisis with the interposition of synthetic polyethylene material showed to be an effective technique for flexible flatfoot in symptomatic pediatric patients. Level of Evidence II, Prognostic studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Neglected, developmental hip dislocation treated with external iliofemoral distraction, open reduction, and pelvic osteotomy

2012 ◽  
Vol 21 (3) ◽  
pp. 209-214 ◽  
Author(s):  
Piotr Wojciechowski ◽  
Damian J. Kusz ◽  
Lukasz S. Cieliński ◽  
Sławomir Dudko ◽  
Przemysław L. Bereza
Keyword(s):  
Open Reduction ◽  
Hip Dislocation ◽  
Pelvic Osteotomy ◽  
Developmental Hip Dislocation

scholarly journals Correction of pediatric flexible flatfoot using arthroereisis

2019 ◽  
Vol 13 (2) ◽  
pp. 112-118
Author(s):  
Leandro Paes de Brito ◽  
Cíntia Kelly Bittar ◽  
Mário Sérgio Paulillo de Cillo ◽  
Carlos Daniel Cândido De Castro Filho ◽  
Renê André Reinig Carvalho ◽  
...  
Keyword(s):  
Linear Regression Analysis ◽  
Case Series ◽  
Deformity Correction ◽  
Multiple Linear Regression Analysis ◽  
Implant Loosening ◽  
Level Of Evidence ◽  
Radiographic Images ◽  
Angle Correction ◽  
Flexible Flatfoot ◽  
Selection Of

Objective: The aim of this study was to evaluate the effectiveness of arthroereisis using synthetic polyethylene implants as a method to correct deformities of excessive valgus in pediatric patients with flexible flatfoot (FF). Methods: This was a study of 20 patients between 5 and 12 years of age with symptomatic FF who received surgery between January 2011 and July 2016. Evaluations were made on the basis of the Valenti podoscopic classification, radiographic images, and AOFAS criteria. Patients with preoperative Valenti classification grades of III and IV were selected for the study. These patients received surgical treatment by arthroereisis with the interposition of a synthetic implant in the sinus tarsi, with or without stretching of the Achilles tendon (Vulpius surgery). A multiple linear regression analysis was performed with backward selection of the following variables: Valenti preoperative classification and the preand postoperative Bordelon, Kite, Gould, Meary and Pitch angles that were measured from the radiographic images of the patients who received arthroereisis. Results: Arthroereisis with synthetic material interposition was satisfactory, with 21 of the feet (91% of cases) showing clinical and radiographic improvement with angle correction and improved degree of deformity based on the Valenti classification. Two cases experienced implant loosening. The Bordelon and Pitch angle variables had a significant effect (p<0.05) on the improvement in degree of deformity correction based on the Valenti classification. Conclusion: Arthroereisis resulted in significant improvements in the patients who were studied, with pronounced clinical improvement and high degrees of satisfaction. Level of evidence IV; Therapeutic Studies; Case Series.

scholarly journals Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up

2021 ◽  
pp. 1-7
Author(s):  
Łukasz Wozniak ◽  
Maciej Idzior ◽  
Marek Józwiak
Keyword(s):  
Risk Factors ◽  
Hip Replacement ◽  
Open Reduction ◽  
Survival Rates ◽  
Hip Dislocation ◽  
Femoral Osteotomy ◽  
Fertility Rate ◽  
Level Of Evidence ◽  
Proximal Femoral Osteotomy

Purpose Late-diagnosed dislocated hips underwent open reduction, Dega osteotomy, and proximal femoral osteotomy between 1968 and 1988. The objectives of this study are to assess the survival of hips into adulthood, clinical and radiological outcome, patients’ life perspectives and the risk factors of failure. Methods An assessment of 67 hips treated when younger than five years (<age 5yr. group) and 71 hips in the group aged older than five years (+age 5yr.) was performed. All cases were evaluated clinically and radiographically, and survival was assessed, considering hip replacement as endpoints for failure (abbreviation HR+ refers to hips that underwent hip replacement surgery; HR- refers to hips that have not been replaced at the follow-up). The fertility rate and the social security disability benefits (SSDB) recipiency percentage were calculated. Results The 40-year survival rates were 73% (95% confidence (CI) 71% to 76%) in the <age 5yr. group, 54% (95% CI 51% to 57%) in the +age 5yr. group, 70% (95% CI 67% to 73%) in one-sided dislocations and 57% (95% CI 54% to 60%) in bilateral dislocations. At follow-up, the median Harris hip and Western Ontario and McMaster Universities Osteoarthritis scores were 90.0 and 13.0 (<age 5yr. group, HR-), 74.0 and 28.0 (+age 5yr. group, HR-), 90.0 and 16.0 (<age 5yr. group, HR+) and 84.5 and 11.5 (+age 5yr. group, HR+), respectively. The operation normalized the radiological parameters. The correlation between the grade of femoral head avascular necrosis (AVN) at a median 2.6 years after the operation and the grade of osteoarthritis at follow-up was 0.38 (p < 0.001). The fertility rate was 1.54. In total, 16.0% (aged under five years) and 38.5% (aged over five years) of patients were receiving SSDB (p = 0.003). Conclusion Early failure risk factors are older age at the surgical procedure, high AVN grade and bilateral hip involvement. Still, the results facilitate hip reposition whenever technically manageable, even in teenagers. Level of evidence III

scholarly journals Orthopaedic manifestations of glutaric acidemia Type 1

2020 ◽  
Vol 14 (5) ◽  
pp. 473-479
Author(s):  
Ahmet Imerci ◽  
Kevin A. Strauss ◽  
Geovanny F. Oleas-Santillan ◽  
Freeman Miller
Keyword(s):  
Muscle Tone ◽  
Fluid Management ◽  
Hip Dislocation ◽  
Retrospective Chart Review ◽  
Pelvic Osteotomy ◽  
Posterior Spinal Fusion ◽  
System Level ◽  
Level Of Evidence ◽  
Severe Scoliosis

Purpose Glutaric acidemia type 1 (GA1), a rare hereditary metabolic disease caused by biallelic mutations of GCDH, can result in acute or insidious striatal degeneration within the first few years of life. We reviewed the orthopaedic sequelae and management of 114 neurologically injured patients with a confirmed molecular diagnosis of GA1. Methods We performed a retrospective chart review spanning 28 years identifying 114 GA1 patients, most from the Old Order Amish population of Lancaster County, Pennsylvania, who were homozygous for a pathogenic founder variant of GCDH (c.1262C>T). We collected demographics, medical comorbidities, muscle tone patterns, Gross Motor Function Classification System level, gastrostomy tube status, seizure history, inpatient events, orthopaedic diagnoses and operative characteristics. Results Over an average follow-up of 4.7 ± 3.4 years, 24 (21%) of 114 patients had musculoskeletal problems requiring orthopaedic consultation. Scoliosis (n = 14), hip dislocation (n = 8/15 hips), hip subluxation (n = 2/three hips), and windswept hip deformity (n = 2) in the spine and hip joint were most common. In total, 35 orthopaedic surgeries were performed in 17 (71%) patients. The most common primary operations were one-stage procedures with proximal femoral varus derotation osteotomy and/or pelvic osteotomy (n = 8/14 hips) for subluxation or dislocation. In all, 11 patients had posterior spinal fusion for severe scoliosis. With the recommended metabolic management, there were no disease-specific complications in this cohort. Conclusions Children with GA1 who have static striatal lesions are at risk for musculoskeletal complications, especially scoliosis and hip dislocation, and appropriate operative management requires consultation with a metabolic specialist with specific considerations for fluid management and nutrition. Level of Evidence IV

scholarly journals OPEN REDUCTION OF HIP DISLOCATION IN PATIENTS WITH ARTHROGRYPOSIS MULTIPLEX CONGENITA – AN ANTEROMEDIAL APPROACH

2010 ◽  
Vol 45 (5) ◽  
pp. 403-408 ◽  
Author(s):  
Luis Eduardo Munhoz da Rocha ◽  
Fábio Koiti Nishimori ◽  
Daniel Carvalho de Figueiredo ◽  
Dulce Helena Grimm ◽  
Luiz Antonio Munhoz da Cunha
Keyword(s):  
Open Reduction ◽  
Hip Dislocation ◽  
Arthrogryposis Multiplex Congenita
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