Aims

To assess the long-term effect of distal trochanteric transfer (DTT) on the clinical and radiographic outcomes of patients with Legg-Calvé-Perthes’ disease (LCPD) following a varus derotational osteotomy (VDRO).

Introduction: Recurrent clubfoot deformity continues to present a problem in pediatric orthopedic practice. Because of the complexity of feet deformation, the correction represents a significant challenge even for orthopedists having experience in work with the Ilizarov device.

Materials and Methods: We apply the Ilizarov fixator consisting of a base from two rings on a shin, an anterior support on the foot – the half ring perpendicular to metatarsal bones and a posterior support from the extended half ring attached to the heel. Anterior and posterior supports are attached to the base by standard details of the Ilizarov apparatus and remain unconnected between them. Such a frame design allows independent and simultaneous correction of forefoot and hind-foot deformities. From 1999–2006, 9 patients aged 3–30, 13 feet with recurrent clubfoot were treated with this technique. Three patients were females and 6 were males. Closed correction was perform in 5 cases, mid-foot osteotomy 4 cases triple arthrodesis 4 cases. The average deformity was: forefoot (supination – 30° FFA – 30°) hind foot (supination 35° equinus 40°).

Results: The correction commenced on fourth-seventh day after surgery. Corrections of deformity were achieved in all cases. The average correction period was 8 weeks. Fixation after complete correction was 6–8 weeks. Complications included pin-tract infection 16%, flexion contracture of toes – 87.5%, and severe pain during deformity correction 33%. On mean follow-up of 40 months all patients had good functional outcome.

Conclusion: Our frame variant is easy to compose, requires only standard components and allows good correction of all foot deformities.

Aim: To evaluate the long term effect of Distal transfer of the greater trochanter in Perthes’ disease.

Patients and methods: Twelve patients (thirteen hip joints, 10 males and 2 females) who suffered from Perthes’ Disease were treated by distal transfer of the greater trochanter (DTT). The operation was performed because of progressive shortening of the articulo-trochanteric distance accompanied by signs of insufficiency of the hip abductors. Total or near total femoral head involvement was found in all the patients except for one of them. Follow up period was 28 years (21–35). Mean age at diagnosis of Perthes’ was 7 years (4–11). Patient were studied in 1992 and reviewed again 13 years later, using the Harris hip score, short form 36 (SF36), physical examination and A-P X-rays.

Results: Not one of the patients underwent a total hip arthroplasty. Mean Harris hip score is 80 (range 54–100, 4 patients under 70 score). Mean SF36 score was 71 (range 30–94) and was correlated to the Harris score. Three of the patients were working in a physically demanding profession. The rest were office workers. Two of them chose non strenuous type of work due to the hip condition. Limb length discrepancy was 1.7 cm short on the operated side (range 0–3) and correlated with Trendelenburg sign (4 patients with positive sign). Femoral head sphericity according to Stulberg classification was good in 5 patients (grades 1–2), fair in 3 patients (grade 3) and poor in 4 patients (grade 4–5). Head sphericity was not correlated to age at diagnosis, Harris score, SF36 score or level of hip pain.

Conclusions: Long term outcome are surprisingly good in those patients, considering the degree of head involvement, advanced age at diagnosis and severity of disease which necessitated high degree of varus osteotomy and hence trochanter transfer.