PURPOSE OF THE STUDY This paper aims to detect, through a retrospective study, the migration of the tips of used metal implants (K-wires or a screw) in the direction out from the proximal femoral epiphysis as a part of studied basic radiometric characteristics of the cohort, with no intention of the authors to evaluate the therapy outcomes. MATERIAL AND METHODS It was a retrospective multicentre study including patients of two orthopaedic clinics and one department of orthopaedics treated in the period 2005-2018. The same treatment procedure was used in all three centres. The "in situ" fixation was indicated in patients, in whom the Southwick angle in anteroposterior and Lauenstein views was not much greater than 30°, whether primarily due to a mild slip or thanks to careful reduction either in acute or acute-on-chronic forms. All X-rays were measured by a single author (M.S.). In AP and Lauenstein view, overlap of the implant tip (K-wire or a screw) above the subcapital growth plate, the height of epiphysis and Southwick angle are measured at the beginning and at the end of treatment. In a smaller group of patients, also the inter-observer error (M.S. and J.P.) was identified. RESULTS K-wire transfixation was used in 43 patients (50 joints), with the mean age of 11.7 years and the mean duration of transfixation of 18.2 months. The slip of the implant tip out of the head, assessed separately for each introduced K-wire and then averaged, was in both views considered statistically significant (in AP view the level of significance was 5% (p-value = 1.393 x 10^(-6) < 0.05) , in Lauenstein view the level of significance was also 5% (p-value = 0.0001652 < 0.05)). The Wilcoxon signed rank test with continuity correction was used. Transfixation by screw alternatively with one K-wire was used in 23 patients (28 joints), with the mean age of 12.4 years and the mean duration of transfixation of 14.4 months. The slip of the screw tip outside the head was assessed as significant (in AP view at the level of significance of 5% (p-value = 9.41 x 10^(-5) < 0.05), in Lauenstein view at the level of significance of 5% (p-value = 0.003557 < 0.05)). The Wilcoxon signed rank test with continuity correction was used. DISCUSSION This paper aims to detect, through a retrospective study, the so-called migration of the tips of used metal implants (K-wires or a screw) outside the femoral head. Smooth and thin implants such as Kirschner wires should not compromise the continuing growth from subcapital growth plate contrary to the AO screw with threads in the femoral head, the screw head rested against the lateral cortical bone and the screw inserted as a compression one. Nonetheless, with some exceptions, the literature confirms the continued growth of the femoral neck even in the case of screws. In general, implants that do not compromise femoral neck growth provide an opportunity to remodel the anterolateral prominence of the femoral metaphysis, especially in younger patients. In agreement with other authors, the data from our study confirmed, even after a short period of time, a certain degree of proximal femoral remodelling expressed by changes in the Southwick angle. CONCLUSIONS Our study confirmed that in the case of "smooth" K-wires as well as cannulated screws the tips of both implants migrate outside the head. The differences were statistically significant. Therefore, the introduction of a conventional cannulated screw cannot be claimed to immediately produce the effect of epiphyseodesis. Yet, smooth implants less compromise the growth of the femoral neck, which is why they have recently been preferred. Key words: coxa vara adolescentium, metal implants, migration.
- MeSH
- coxa vara diagnostické zobrazování diagnóza patologie MeSH
- dítě MeSH
- kyčelní kloub * abnormality diagnostické zobrazování patologie MeSH
- lidé MeSH
- nádory kostí diagnóza komplikace patologie MeSH
- Perthesova nemoc diagnostické zobrazování diagnóza MeSH
- rentgendiagnostika metody MeSH
- vývojová dysplazie kyčelního kloubu diagnóza etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- hyperkyfóza,
- MeSH
- bolesti zad diagnóza terapie MeSH
- coxa vara diagnóza terapie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- entezopatie diagnóza terapie MeSH
- lidé MeSH
- mladiství MeSH
- muskuloskeletální abnormality klasifikace MeSH
- muskuloskeletální nemoci * diagnóza etiologie klasifikace patologie terapie MeSH
- nekróza hlavice femuru diagnóza patofyziologie terapie MeSH
- nemoci kostí diagnóza terapie MeSH
- osteochondróza diagnóza patologie terapie MeSH
- osteonekróza etiologie patologie MeSH
- plochá noha diagnóza etiologie farmakoterapie MeSH
- postura těla fyziologie MeSH
- skolióza diagnóza etiologie patologie terapie MeSH
- tortikolis diagnóza etiologie MeSH
- vrozené deformity nohy (od hlezna dolů) diagnóza patofyziologie MeSH
- vývojová dysplazie kyčelního kloubu diagnóza prevence a kontrola MeSH
- zatížení muskuloskeletálního systému MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- MeSH
- artroplastiky kloubů * metody trendy využití MeSH
- coxa vara chirurgie terapie MeSH
- fraktury femuru chirurgie komplikace MeSH
- fraktury krčku femuru chirurgie terapie MeSH
- kongresy jako téma MeSH
- lidé MeSH
- ortopedické výkony * metody trendy využití MeSH
- ortopedie * metody organizace a řízení výchova MeSH
- osteotomie metody trendy využití MeSH
- věkové faktory MeSH
- vnitřní fixace fraktury metody využití MeSH
- Check Tag
- lidé MeSH
- Klíčová slova
- chondrolýza,
- MeSH
- coxa vara * diagnostické zobrazování etiologie chirurgie MeSH
- diagnostické zobrazování metody MeSH
- dítě MeSH
- kloubní chrupavka patologie MeSH
- kostní dráty využití MeSH
- lidé MeSH
- nekróza hlavice femuru etiologie MeSH
- nekróza etiologie terapie MeSH
- nemoci chrupavky MeSH
- ortopedické výkony metody využití MeSH
- osteotomie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Indikací k intertrochanterickým steotomiím po zavedení TEP kyčle značně ubylo. Přesto zůstává intertrochanterická osteotomie pro řadu deformit a onemocnění kyčelního kloubu metodou volby. Ne každý ortoped musí zvládnout provedení této operace, ale každý by měl o ní vědět a znát její indikace.
Since the introduction of THA, the number of indications for intertrochanteric osteotomy has significantly decreased. In spite of this fact, intertrochanteric osteotomy remains the therapeutic method of choice for a number of deformities and diseases of the hip. Not all orthopaedic surgeons are able to manage this operation, but each of them should be aware of it and know its indications.
- MeSH
- coxa vara chirurgie MeSH
- femur * chirurgie patofyziologie patologie MeSH
- kloubní deformity získané chirurgie MeSH
- kyčelní kloub * abnormality chirurgie patologie MeSH
- lidé MeSH
- nekróza hlavice femuru chirurgie MeSH
- nestejná délka dolních končetin chirurgie MeSH
- osteotomie * klasifikace metody MeSH
- pseudoartróza chirurgie MeSH
- vývojová kyčelní dysplazie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate, in comparison with the pre-operative planning, the accuracy of proximal femur correction achieved with the use of locking compression paediatric hip plates (LCP) in children and adolescents and to assess pre- and post-operative complications. MATERIAL AND METHODS: A group of 52 patients in whom proximal femoral osteotomy using the LCP was performed on a total of 55 hips between September 2009 and February 2013 were retrospectively evaluated. The following diagnoses were treated: unstable hip in cerebral palsy, 18 operations; Legg-Calvé-Perthes disease, 10 operations; coxa vara of aetiology other than coxa vara adolescentium (CVA), eight operations; true CVA, six operations; femoral shortening by the Wagner method, six procedures; proximal femoral derotation osteotomy, four procedures; and post-traumatic pseudoarthrosis of the proximal femur, three operations. RESULTS: Compared with the pre-operative plan, the average deviation of the colodiaphyseal angle was 5.2° (1° to 11°) in 18 unstable hips; 4.7° (1° to 10°) in 10 cases of Legg-Calvé-Perthes disease; 4.5° (3° to 6°) in eight hips with coxa vara of aetiology other than CVA; 6.5° (2° to 13°) in six CVA hips; 4.5° (1° to 10°) in six cases of femoral shortening; 3.5° (1° to 5°) in four derotation osteotomies; and 3.7° (0° to 6°) in three corrections of pseudoarthrosis. In one patient, osteosynthesis failed due to screws being pulled out from the proximal fragment; re-osteosynthesis was carried out using a conventional angled blade plate. DISCUSSION: As in other international studies, our results confirmed a high accuracy of proximal femur correction with use of the LCP instrumentation. The reported higher time requirement for this technique seems to be related to the learning curve and, with more frequent use, will probably be comparable to the time needed for application of conventional hip angled plates. CONCLUSIONS: The up-to-date LCP fixation system using the principle of angular stability for correction of the proximal femur in children is a clear advancement and its higher costs are certain to be outweighed by its higher accuracy and thus better results.
- MeSH
- coxa vara etiologie chirurgie MeSH
- dítě MeSH
- femur chirurgie MeSH
- kostní destičky * MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna komplikace MeSH
- nestabilita kloubu etiologie chirurgie MeSH
- osteotomie přístrojové vybavení metody MeSH
- Perthesova nemoc komplikace MeSH
- pseudoartróza chirurgie MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
- srovnávací studie MeSH
PURPOSE: Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents. METHODS: Eleven patients with an average age of 17 (range 14-26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48-132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO). RESULTS: In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient. CONCLUSION: Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.
- MeSH
- coxa vara etiologie chirurgie MeSH
- dospělí MeSH
- fraktury krčku femuru komplikace patologie chirurgie MeSH
- hlavice femuru patologie chirurgie MeSH
- kohortové studie MeSH
- kyčelní kloub patofyziologie chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nekróza hlavice femuru etiologie patologie chirurgie MeSH
- obnova funkce MeSH
- osteotomie MeSH
- pooperační komplikace MeSH
- posuzování pracovní neschopnosti MeSH
- remodelace kosti MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Ischemic necrosis of the proximal femur resulting in coxa vara is a severe iatrogenous complication of the treatment of developmental dysplasia of the hip (DDH). Severe relative overgrowth of the greater trochanter and reduction of the neck result in insufficiency of hip abductors. Unequal limb length causes obliquity of the pelvis, compensatory scoliosis of the lumbar spine and valgus deformity of the ipsilateral knee. The purpose of this study was to investigate the effect of valgus intertrochanteric osteotomy in patients with coxa vara older than 30 years. METHODS: Fifteen female patients of the average age 43 years (range 31-60) with postdysplastic varus deformity of the proximal femur and shortening of affected limb of 2-4 cm were treated with valgus intertrochanteric osteotomy. None of them was operated on before. In eight cases, the varus deformity of the proximal femur was evaluated as Bucholz-Ogden Type II, in seven cases as Bucholz-Ogden Type III. The average follow-up was 10 years (range 5-20). RESULTS: By the time of the last functional follow-up, three patients had already underwent conversion of osteotomy to total hip arthroplasty (THA), namely, 7.5, 11, and 12 years after osteotomy. All the patients evaluated the effect of osteotomy positively, including those treated later with THA. The average preoperative Harris Hip Score was 83, the postoperative one was 93. CONCLUSIONS: Based on results, the valgus intertrochanteric osteotomy appears to be a reliable treatment for postdysplastic coxa vara in patients older than 30 years.
- MeSH
- coxa vara etiologie radiografie chirurgie MeSH
- dospělí MeSH
- femur radiografie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- následné studie MeSH
- osteonekróza komplikace MeSH
- osteotomie metody MeSH
- pooperační komplikace MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- vývojová kyčelní dysplazie komplikace terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
