scholarly journals Developmental dislocation of the hip is still important problem: Therapeutic guidelines

2006 ◽  
Vol 53 (4) ◽  
pp. 17-19 ◽  
Author(s):  
Z. Vukasinovic ◽  
C. Vucetic ◽  
G. Cobeljic ◽  
Z. Bascarevic ◽  
N. Slavkovic
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Nonoperative Treatment ◽  
Leg Length ◽  
Leg Length Inequality ◽  
Important Complication ◽  
Therapeutic Guidelines ◽  
Second Year ◽  
Dislocation Of The Hip ◽  
Hip Necrosis

The authors are describing currently important problem - developmental dislocation of the hip. Guidelines for the treatment have been given according to literature date and upon their own experience. Therapeutic suggestions for the first twelve months of life are based on the ultrasound typing - it is advised to perform nonoperative treatment (abduction devices, "over head" traction, Pavlik harnesses). During the second year of life a pause in the treatment should be advised in order to avoid postreduction avascular hip necrosis as a very important complication. After that period surgical treatment has to be done (open reduction, pelvic and femoral osteotomies). Special suggestions have been given for the treatment of consecutive leg length inequality and the deformities caused by postreduction avascular hip necrosis.

scholarly journals Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 266 ◽  
Author(s):  
Abuzer Uludağ ◽  
Hacı Bayram Tosun
Keyword(s):  
Surgical Treatment ◽  
Open Fractures ◽  
Tibial Shaft ◽  
Leg Length ◽  
Leg Length Inequality ◽  
Shaft Fractures ◽  
Elastic Nails ◽  
Closed Fractures ◽  
The Mean ◽  
Tibial Shaft Fractures

Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

scholarly journals Surgical treatment of the congenital dislocation of the hip after walking age: open reduction and Salter's osteotomy

2003 ◽  
Vol 11 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Guaracy Carvalho Filho ◽  
Alceu Gomes Chueire ◽  
Helencar Ignácio ◽  
Márcio de Oliveira Carneiro ◽  
João Francese Neto ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Weight Bearing ◽  
Clinical Results ◽  
Congenital Dislocation ◽  
Radiological Criteria ◽  
Clinical Criteria ◽  
Innominate Osteotomy ◽  
Walking Age ◽  
Dislocation Of The Hip

The congenital dislocation of the hip, after the function of weight bearing begins or walking phase requires surgical treatment, and one of the options is the open reduction combined to innominate osteotomy (Salter). In this study, the results of 18 patients, 22 surgically treated hips with congenital dislocation, were evaluated from 1989 and 1995, using innominate osteotomy, by Salter's technique after open reduction. The age of the patients at the time of surgery ranged from 12 to 30 months (age after march), mean age of 19 months. Fifteen were female and 3 were male, 4 patients had bilateral dislocation and in the remaining, 8 had their left hip dislocated and 6 had their right hip dislocated. The results were evaluated according to Dutoit et al.(3) clinical criteria and to Severin(12) radiological criteria, after a mean follow-up of 48 months. Eighteen percent of excellent clinical results (4); 54% of good results (12); 14% of regular results (3) and 14% of bad results(3) were obtained. As to the radiologic criteria, 36% of the hips were classified as excellent (8); 45% as good (10); 5% regular (1) and 14% bad (3). There were 3 cases of re-dislocation which were treated by a different surgical technique. No cases of infection, graft fracture and vascular or nervous injury were reported.

scholarly journals choice of surgical tactics for the treatment of children with destructive pathological dislocation of the hip after hematogenous osteomyelitis

2021 ◽  
Vol 5 (1) ◽  
pp. 15-20
Author(s):  
Akhror Makhmutovich Djuraev ◽  
Khojaakhmed Shaykhislamovich Alpisbaev ◽  
Elyar Abduvalievich Tapilov
Keyword(s):  
Surgical Treatment ◽  
Hip Joint ◽  
Proximal Femur ◽  
Surgical Approach ◽  
Open Reduction ◽  
Pelvic Osteotomy ◽  
Hematogenous Osteomyelitis ◽  
Surgical Tactics ◽  
The Stability ◽  
Dislocation Of The Hip

A surgical approach to the treatment of destructive pathological dislocation of the hip in children has been substantiated, depending on age, the severity of destruction of the proximal femur and acetabulum. Reconstructive - restorative operations in most patients ensure the stability of the hip joint and thereby improve the patient's gait and statics, reduce the pelvic misalignment and eliminate the Trendelenburg symptom. The experience of surgical treatment of patients with pathological hip dislocations has shown that the most favorable outcomes are achieved with the use of open reduction of the stump of the head or neck of the femur with intertrochanteric detorsion shortening and varizing osteotomy with rotational pelvic osteotomy according to Salter and acetabular plasty according to Pemberton.

Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination

2018 ◽  
Vol 46 (13) ◽  
pp. 3174-3181 ◽  
Author(s):  
K.J. Hippensteel ◽  
Robert Brophy ◽  
Matthew Smith ◽  
Rick Wright
Keyword(s):  
Surgical Treatment ◽  
Surgical Procedure ◽  
Open Reduction ◽  
Screw Fixation ◽  
Nonoperative Treatment ◽  
Open Reduction Internal Fixation ◽  
Readmission Rates ◽  
Ac Joint ◽  
Suspensory Fixation ◽  
Specific Factors

Background: High-grade acromioclavicular (AC) joint separations are relatively rare injuries that are often treated surgically, yet more information is needed about the risks of various surgical procedures in terms of considering and counseling patients regarding operative versus nonoperative treatment. Purpose: To calculate whether the volume of surgical treatment of AC joint separations increased over a recent 12-year period; to examine the nature and frequency of complications, reoperations, and readmissions associated with these procedures; and to assess whether patient- and surgeon-specific factors or surgical technique affected these rates. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The American Board of Orthopaedic Surgery (ABOS) database for orthopaedic surgeons taking the Part II examination was reviewed from 2005 to 2016 to identify surgical treatment of AC joint separations. The authors calculated the percentage of all surgical cases in the ABOS database and rates of complications, reoperations, and readmissions. Association of these sequelae with patient- and surgeon-specific factors and surgical techniques was assessed. Results: There was no difference in the number or percentage of cases per year over the study period. There was an overall complication rate of 24.5%, a reoperation rate of 7.3%, and a readmission rate of 1.9%. Patients ≥40 years of age had significantly higher complication, reoperation, and readmission rates as compared with patients <40 years of age. There were significant differences in complication, reoperation, readmission, and displacement rates dependent on the type of surgical procedure performed. The highest complication rates were seen with open suspensory fixation, screw fixation, open reduction internal fixation, and arthroscopic coracoclavicular ligament repair or reconstruction. The highest reoperation rates were seen with screw fixation, open reduction internal fixation, and open suspensory fixation. Conclusion: The volume of surgical treatment for AC joint separations did not change significantly over the study period. Complication, reoperation, and readmission rates were dependent on the type of surgical procedure performed and patient age. This information should assist surgeons in discussing risks when considering and counseling patients regarding operative versus nonoperative treatment.

Ligamentum Teres Tenodesis in Medial Approach Open Reduction for Developmental Dislocation of the Hip

2008 ◽  
Vol 28 (6) ◽  
pp. 607-613 ◽  
Author(s):  
Christopher Edward Bache ◽  
H. Kerr Graham ◽  
D. Robert V. Dickens ◽  
Leo Donnan ◽  
Michael B. Johnson ◽  
...  
Keyword(s):  
Open Reduction ◽  
Ligamentum Teres ◽  
Medial Approach ◽  
Dislocation Of The Hip

Leg-Length Inequality in People of Working Age

Spine ◽  
1991 ◽  
Vol 16 (4) ◽  
pp. 429-431 ◽  
Author(s):  
ANNI SOUKKA ◽  
HANNU ALARANTA ◽  
KAJ TALLROTH ◽  
MARKKU HELIÖVAARA
Keyword(s):  
Leg Length ◽  
Leg Length Inequality ◽  
Working Age

scholarly journals Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over

2021 ◽  
Vol 2 (12) ◽  
pp. 1027-1034
Author(s):  
Sondre Hassellund ◽  
Zinajda Zolic-Karlsson ◽  
John Håkon Williksen ◽  
Torstein Husby ◽  
Jan Erik Madsen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Distal Radius ◽  
Controlled Trial ◽  
Cost Effective ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Life Years

Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

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