Europeam Group of Neuro-orthopaedic (GLAENeO), Caracas, The prevention of a dislocated hip is one of the aims of early surgery in Cerebral Palsy children, specially those severely involved. We performed a retrospective study of those cerebral palsy patients operated of
Background: The purpose of this study was to evaluate the results after hallux valgus surgery by transar-ticular
To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification.Aims
Methods
Aims. The significance of the ‘clicky hip’ in neonatal and infant examination
remains controversial with recent conflicting papers reigniting
the debate. We aimed to quantify rates of developmental dysplasia
of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated
DDH clinic. Patients and Methods. A three-year prospective cohort study was undertaken between
2014 and 2016 assessing the diagnosis and treatment outcomes of
all children referred specifically with ‘clicky hips’ as the primary
reason for referral to our dedicated DDH clinic. Depending on their
age, they were all imaged with either ultrasound scan or radiographs. Results. There were 69 ‘clicky hip’ referrals over the three-year period.
This represented 26.9% of the total 257 referrals received in that
time. The mean age at presentation was 13.6 weeks (1 to 84). A total
of 19 children (28%) referred as ‘clicky hips’ were noted to have
hip abnormalities on ultrasound scan, including 15 with Graf Type
II hips (7 bilateral), one Graf Type III hip, and three Graf Type
IV hips. Of these, ten children were treated with a Pavlik harness, with
two requiring subsequent closed reduction in theatre; one child
was treated primarily with a closed reduction and
Patients with myelomeningocele who had had surgery to stabilise the hip were reviewed; the results of the 106 operations in 88 patients were assessed. In the earlier part of the series there were 55 children who had 64 iliopsoas transfers; later in the series 33 children had 42 varus-rotation osteotomies combined with
Background. There are many difficulties during performing total hip replacement in high riding DDH. These difficulties include:. In Acetabular part: bony defect in antero lateral acetabular wall/finding true centre of rotation/shallowness of true acetabulum/hypertrophied and thick capsular obstacle between true and false acetabulum. In Femoral part: small diameter femoral shaft/excessive ante version/posterior placement of greater trochanter. anatomic changes in soft tissue & neurovascular around the hip including: adductor muscle contracture/shortening of abductor muscles/risk of sciatic nerve injury following lengthening of the limb after reduction in true acetabulum/vascular injury. The purpose of this lecture is how to manage above problems with using reinforcement ring (ARR) for reconstruction of true acetabulum and step cut L fashion proximal femoral neck shortening osteotomy in a single stage operation. Method. 23 surgeries in 19 patients, including 18 female and one male were performed by me from Jan. 1997 till Dec. 2009. Six patients had bilateral hip dislocation, but till now only four of them had bilateral stepped operation. Left hip was involved in 15 cases (65.2%). The average age was 40 years old. All hips were high riding DDH according to both hartofillokides and crowe classification. Reconstruction of true acetabulum was performed with aid of reinforcement ring and bone graft from femoral head in all cases. Trochantric osteotomy was done in all, followed by fixation with wire in 22 cases which needed two revisions due to symptomatic non union (9%). Hooked plate was use in one case for trochantric fixation. Due to high riding femur, it was necessary to performed femoral shortening in neck area as a step cut L fashion. In two patient, one with bilateral involvement, after excessive limb lengthening following trial reduction, it was necessary to performed concomitant supracondylar femoral shortening. (3 cases = 13%). 22 mm cup & miniature muller DDH stem were used in 18 cases (78.26%). In 5 cases, one bilaterally, non cemented stem and 28 mm cemented cup in ring were used. Primary
Purpose of study: To assess whether a plane x-ray at five months is needed in a DDH screening program. Method: Between 1990 and 2004 we operated selective hip screening, including ultrasound. Hips screened as normal had an X-ray at 5 months, initially instituted to cover the ultrasound learning curve. These were reported by a consultant radiologist and referred if thought abnormal. For the purposes of this study the notes, scans and X-rays of all patients referred at 5 months were reviewed. Results: In Nottingham there were approximately 108,500 births between 1990 and 2004. Of these 11,425 were referred for ultrasound scan. 53 were referred to orthopaedics following the x-ray at 5 months. 47 of these had a complete data set. Of these 47 children, 30 (64%) were watched, 9 (19%) had arthrograms only, 5 (11%) had
We evaluated long-term follow-up clinically and radiologically of patients with developmental dysplasia of the hip operated between 1956 and 1971 with
Protrusio acetabuli can be either primary or secondary. Primary or idiopathic protrusio is a rare condition of unknown etiology. Secondary protrusio may be associated with rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteomalacia, trauma and Paget's disease. Challenges in surgery include: lack of bone stock, deficient medial support to the cup, difficulty in dislocating the femoral head, and medialization of the hip joint center. Several surgical techniques have been described: use of cement alone without bone graft; morselised impacted autograft or allograft with a cemented cup; metal cages, reinforcement rings, and solid grafts. We describe our technique of impaction grafting using autologous bone and a cementless porous-coated hemispherical cup without the use of acetabular rings or cages in patients with an average age of 46 years. Protrusion was graded depending on distance of medial wall from Kohler's line as mild (1–5 mm medial), moderate (6–15 mm medial) and severe if it was more than 15 mm medial to the Kohler's line. All patients were operated in the lateral position using a modified Hardinge's anterolateral approach.
In juvenile chronic arthritis the hips are commonly affected and this becomes the most important reason for losing independence and mobility: the joint develops a painful flexion contracture with marked loss of movement. Soft-tissue release operations consisting of psoas and
1. There is an increasing prevalence in the evidence of prenatal extended knee postures in the legs of newborn, from normal births to breech deliveries and to babies with hip displacements. The extended knee postures are also commoner in female births. 2. Babies with reducible hip displacements appear to be born more often in summer as the result of winter conceptions. Spontaneous recovery is very high, with or without splintage. 3. Irreducible hip displacement does not respond to splintage during the first six months of life. Even with
We studied the pathogenesis, incidence and consequences of avascular necrosis in 184 children treated for congenital dislocation of the hip. Of 210 hips, 99 (47%) had some evidence of avascular necrosis (total 81, partial 18). The incidence was not influenced by the age at reduction, the duration of traction or the use of
Introduction. Hip and groin injuries are common in athletes participating in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion injuries involving tendons attaching to the symphysis pubis have previously been described and can be managed both operatively and non-operatively. The aim is to describe a rare variant of this injury; complete avulsion of the adductor sleeve complex including adductor longus, pectineus and rectus abdominus. A surgical technique is then outlined which promotes a full return to pre-injury level of sporting activity. Patients/Materials & Methods. Fifteen high level athletes with an MRI confirmed acute adductor complex avulsion injury (6–34 days) were identified from the institution's sports injury database over a 10 year period. All underwent surgical repair. The operative procedure comprised anatomical attachment of the avulsed tissues in all cases (plus mesh reinforcement of the inguinal wall in 7 patients). All underwent a standard format of rehabilitation which was then individualised to be sport specific. Results. One patient developed a superficial wound infection which was successfully treated with antibiotics. 12 out of 15 patients complained of transient local numbness which resolved in all cases. All patients (including 7 elite athletes) returned to their previous level of participation in sport. Discussion. Injury to the triad of adductor longus, pectineus and rectus abdominus should be considered in athletes presenting with groin pain following forced adduction. All athletes underwent early surgical exploration, previous studies have shown prolonged symptoms in early conservative management.
Sixty-one patients with 68 osteonecrotic femoral heads, at different stages of development, were treated surgically; their average age was 36 years. Necrosis followed a fracture in 43 hips and traumatic dislocation in three. It was idiopathic in 14, cortisone-induced in seven and associated with gout in one. The operation of multiple drilling, curettage of the necrotic bone and muscle pedicle bone grafting was performed in all. Cheilectomy of the superolateral part of the femoral head and
Conventional methods of imaging in the investigation of developmental dysplasia of the hip all have disadvantages, either in definition or in exposure to radiation. We describe a new open-configuration MR scanner which is unique in that it allows anaesthesia and access to the patient within the imaging volume for surgical procedures and application of casts. We performed 13 scans in eight anaesthetised infants. Dynamic imaging revealed two dislocated hips which were then visualised during reduction. Hip spicas were applied without removing the patient from the scanner. In one hip, an
Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by
Protrusio acetabuli can be either primary or secondary. Primary or idiopathic protrusio is a rare condition of unknown etiology. Secondary protrusio may be associated with rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteomalacia, trauma and Paget's disease. Challenges in surgery include lack of bone stock, deficient medial support to the cup, difficulty in dislocating the femoral head, and medialisation of the hip joint center. Several surgical techniques have been described: use of cement alone without bone graft; morsellised impacted autograft or allograft with a cemented cup; metal cages, reinforcement rings, and solid grafts. We describe our technique of impaction grafting using autologous bone and a cementless porous-coated hemispherical cup without the use of acetabular rings or cages in patients with an average age of 46 years. Protrusion was graded depending on distance of medial wall from Kohler's line as mild (1–5mm medial), moderate (6–15mm medial) and severe if it was more than 15mm medial to the Kohler's line. All patients were operated in the lateral position using a modified Hardinge's anterolateral approach.
Purpose. The hip region is the second most common site for tuberculosis following the spine in children. The aim is to describe the variable radiological patterns of presentation and their resemblance to pyogenic infection, tumours and other benign conditions of bone in children. Methods. The clinical and radiological records of 29 children aged 10 months–13 years with confirmed tuberculosis of the hip region seen between 1990 and 2011 were reviewed retrospectively. Clinical features were pain, limp and flexion, adduction contractures. Abscesses and sinuses were seen in 4 children. The ESR ranged between 7–110 mm/hr. Mantoux was positive in 20 children. All cases were histologically confirmed. Treatment involved biopsy, currettage of bone defects, limited synovectomy and
We present a novel use for an adult proximal humeral locking plate. In our case an 18-year-old female with cerebral palsy sustained a peri-prosthetic fracture of a blade plate previously inserted for a femoral osteotomy. Treatment was revision using a long proximal humeral locking plate. She had a successful outcome. We present the history and operative management. The female had a history of quadriplegic cerebral palsy, asthma, diabetes mellitus and congenital heart disease. She had a gastrostomy tube for enteral feeding. She was on nutritional supplements, baclofen, Omeprazole and movicol. She is looked after by her parents and requires a wheelchair for mobility. She is unable to communicate. Surgical History: Right
Protrusio acetabuli can be either primary or secondary. Primary or idiopathic protrusio is a rare condition of unknown etiology. Secondary protrusio may be associated with Rheumatoid Arthritis, Ankylosing spondylitis, osteoarthritis, osteomalacia, trauma and Paget's disease. Challenges in surgery include lack of bone stock, deficient medial support to the cup, difficulty in dislocating the femoral head, and medialisation of the hip joint centre. Several surgical techniques have been described: use of cement alone without bone graft; morsellised impacted autograft or allograft with a cemented cup; metal cages, reinforcement rings, and solid grafts. We describe our technique of impaction grafting using autologous bone and a cementless porous-coated hemispherical cup without the use of acetabular rings or cages in patients with an average age of 46 years. Protrusion was graded depending on distance of medial wall from Kohler's line as mild (1–5 mm medial), moderate (6–15 mm medial) and severe if it was more than 15 mm medial to the Kohler's line. All patients were operated in the lateral position using a modified Hardinge's anterolateral approach.
