A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes. A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures. Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %). Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.
- MeSH
- fraktury kyčle chirurgie MeSH
- hlavice femuru zranění chirurgie MeSH
- lidé MeSH
- luxace kyčle chirurgie MeSH
- náhrada kyčelního kloubu metody MeSH
- pooperační komplikace epidemiologie MeSH
- vnitřní fixace fraktury * metody MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY Different techniques have been reported to reconstruct the defi cient acetabulum during total hip arthroplasty (THA). The purpose of this study was to compare the biomechanical features of the bulk bone graft (BBG) technique (Harris acetabular plasty) and the Roof Step Cut (RSC) technique using fi nite element analysis. MATERIAL AND METHODS Based on a female patient's dysplastic hip CT scan, 3D models were assembled according to the two techniques. For the Harris technique, an irregular BBG was sculpted from a solid sphere, while for the RSC technique, the graft was sculpted into a step-cut shape with a similar size. Each graft was fi xed with two compression screws at two different angles (0° and 45°). Four fi nite element models were used to compare the von Mises stress distribution and total deformation of the grafts and the screws. The pressure and sliding distances of the contacts between the bone graft, metal cup and acetabular host bone were also analyzed. RESULTS For both of the bone grafts and the screws, compared to the Harris models, the maximum stress of the RSC models was signifi cantly lower (16.56 MPa, 25.50 MPa vs 97.13 MPa, 112.72 MPa) and the total deformation was signifi cantly smaller (0.0096 mm, 0.0089 mm vs 0.022 mm, 0.018 mm). 45° inserted screws generated higher stress at the end of the screws and on the outside of the bone graft. In case of 0° inserted screws, the maximum value was mainly located in the middle of the screws, inside the screw channel as well as at the contact area between the graft and the host bone. At all analyzed contacts, the RSC technique shows signifi cantly lower pressure and sliding distances, irrelevant to the screw's insertion angle. In comparison, the model of BBG with 45° screws showed a signifi cant sliding effect and higher contact pressure. CONCLUSIONS Compared with the BBG technique, the step-shaped graft of the RSC technique could signifi cantly reduce the maximum stress and deformation of the graft and the screws, and decrease the pressure and sliding distance between the bone graft, metal cup and the acetabular host bone. The angle of screw placement affects the location of stress and deformation. Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabular reconstruction, bone graft, fi nite element analysis.
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
- MeSH
- acetabulum MeSH
- dítě MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle * diagnostické zobrazování etiologie chirurgie MeSH
- mladiství MeSH
- mozková obrna * komplikace chirurgie MeSH
- následné studie MeSH
- pánev MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.
BACKGROUND: Femoral posterior hip dislocation with associated femoral head fractures (Pipkin fractures) are rare high-energy injuries. Published treatment modalities involve conservative treatment, head fragment resection, open reduction and internal fixation, and total hip replacement. The experience with mini-invasive screw osteosynthesis of these fractures is the main focus of our study. METHODS: Seven Pipkin fractures (five Pipkin II and two Pipkin I) in six patients were treated by closed reduction of hip dislocation, followed by minimal invasive lag screw osteosynthesis. Cancellous screw(s) were inserted from the incision on the lateral hip through the femoral neck to the reduced fracture fragment. In all patients, postoperative CT was performed to check the quality of surgery. Active physiotherapy with immediate toe-touch weight bearing was the routine postoperative protocol. In all patients, radiological and clinical results were evaluated with the Thompson Epstein, Merle d'Aubigne and Postel score, and Harris hip score. RESULTS: All fractures united, and all femoral heads survived. Infectious complications were not observed, and no secondary surgery was needed. After an average follow-up of 18.4 months, the average Merle d'Aubigne and Postel score was 17.7 points, while the mean Harris hip score reached 98.1 points. The majority of patients achieved an excellent Thompson-Epstein clinical and radiological outcome. All patients returned to their original occupation. CONCLUSIONS: Mini-invasive screw osteosynthesis can be used for the treatment of Pipkin type I-II femoral head fractures. Successful reduction of hip dislocation and head fracture is necessary for using this technique. Long-term follow-up is necessary to confirm this technique.
- MeSH
- fraktury femuru * komplikace chirurgie MeSH
- fraktury kyčle * diagnostické zobrazování chirurgie komplikace MeSH
- hlavice femuru diagnostické zobrazování chirurgie zranění MeSH
- kostní šrouby škodlivé účinky MeSH
- lidé MeSH
- luxace kyčle * komplikace chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The study aimed to evaluate the intraoperative and early postoperative response to simultaneous bilateral femoral osteotomy usually accompanied by soft tissue release of hip joints, or open reduction, capsuloplasty, pelvic osteotomy or extraarticular shelf procedure. MATERIAL AND METHODS A bilateral surgery was performed in 16 children. Twelve children suffered from (spastic) cerebral palsy and there was one case of paralytic dislocation in a patient with myelomeningocele, while the remaining patients suffered from chromosome I aberrations, Dandy-Walker syndrome and merosin-deficient muscular dystrophy. GMFCS Level IV and V prevailed. The patients with femoral head deformity or severe adduction contracture were removed from the study group. In all cases the LCP Pediatric Hip Plate 3.5 or 5.0 (Synthes) was used for osteosynthesis. The postoperative fixation by a hip spica cast was applied for 6 weeks, after which in most cases SWASH orthosis was used at night. The age of the patient, the hip joint finding, the GMFCS level and the type of procedure were recorded. RESULTS The evaluation took into account the use of general anaesthesia only or a combination of general and epidural anaesthesia, most often through caudal block, duration of surgery, time when blood transfusion was necessary and the volumes of blood needed, duration of stay in the Anaesthesiology and Resuscitation Unit, or Intensive Care Unit. As a response to surgery, the changes in haemoglobin levels in g/l and VAS pain score were studied. In four patients only the operative time exceeded 3 hours. Blood transfusion was necessary in 13 patients, with one blood unit being always sufficient. Two patients were admitted to the Anaesthesiology and Resuscitation Unit, the remaining patients spent 1-3 days after surgery in the ICU. The average length of hospital stay did not exceed a week. The postoperative decrease in haemoglobin levels quickly improved. The pain intensity was regularly recorded postoperatively and on day 3-4 it was evaluated as moderate, with patients responding well to common analgesics (VAS 4-7). DISCUSSION The evaluation of duration of simultaneous bilateral procedure, postoperative recovery based on the need for blood transfusion, changes in blood count and VAS scores indicated that the procedure performed on both hip joints simultaneously does not significantly exceed the reasonable limits in terms of the patient s burden. In literature, we found only a single article on a topic of this sort, the conclusions of which are very similar. CONCLUSIONS The simultaneous bilateral femoral osteotomy can be considered a fairly safe procedure. Key words: hip joint instability, simultaneous femoral osteotomy, cerebral palsy.
- MeSH
- dítě MeSH
- femur MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle * chirurgie MeSH
- mozková obrna * MeSH
- osteotomie MeSH
- retrospektivní studie MeSH
- studie proveditelnosti MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
x
x
- MeSH
- dislokace kloubu * chirurgie etiologie MeSH
- dospělí MeSH
- hlezenní kloub chirurgie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace kolena chirurgie etiologie MeSH
- luxace kyčle chirurgie etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY To evaluate the results of treatment of acute and chronic severe slips of slipped capital femoral epiphysis. The tested hypothesis was that the results will be comparable with the methods using surgical hip dislocation. MATERIAL AND METHODS In the period 1996-2014, 26 patients were treated for severe slips ( >60°). Boys prevailed (2:1) and were older on average (the mean age 13.8 vs.12 years). Chronic stable slips prevailed (16 patients) and were followed by acute-on-chronic slips (7 patients) and with acute slips (3 patients). The acute unstable slips were treated using closed reduction and transphyseal fixation. The acute-on-chronic slips were treated using closed reduction and fixation (2 patients) and subcapital osteotomy (5 patients), respectively. Chronic slips were treated as follows: with subcapital osteotomy (10 patients); with intertrochanteric femoral osteotomy (5 patients); and with transphyseal fixation without correction (1 patient). 22 patients were treated concurrently on the contralateral side as a prevention or to treat the slips. The follow-up ranged from 20 months to 13 years. The clinical results were evaluated according to four scores: 1) our own score (NB score) based on the reduction of ROM, shortening of extremity and limitations in activities; 2) Merle d'Aubigne score; 3) Harris hip score (HHS); 4) non arthritic hip score (NAHS). In the radiological evaluation, correction of slip angle, alpha-angle, avascular necrosis (AVN) and grade of arthrosis according to Toennis were observed. RESULTS According to the NB score 10 excellent results (38%), 11 very good results (42%), one good and one satisfactory result (4%) and 3 unsatisfactory results (11%) were achieved. According to the other scores the following results were reported: a) excellent: D'Aubigne-Postel - 19 (73%); HHS - 20 (77%); NAHS - 21(81%), b) good: D'Aubigne and HHS- 3 (11%); NAHS - 2 (8%), c) satisfactory: D 'Aubigne - one (4%), HHS and NAHS 0, d) unsatisfactory: D'Aubigne, HHS and NAHS - 3 (11%). The evaluation of surgical methods shows that the best results were achieved by closed reduction of acute slips (with 80% excellent results). The result of transphyseal fixation without reduction was satisfactory only. The intertrochanteric osteotomy led mostly to very good results (80%) and then to the excellent results (20%). After subcapital osteotomy, mostly excellent and very good results (40% each) were reported, followed by two unsatisfactory results (13%) and one good result (7%). As concerns the slip reduction and alfa angle, the best results were achieved by closed reduction and subcapital osteotomy. The FAI was observed/ in 10 patients. Arthrosis was observed as follows: grade I in 8 patients, grade II in 3 patients. The AVN was present as segmental in 4 patients (15%) and as complete in two patients (8%), namely in one after closed reduction and in one after subcapital osteotomy. Dislocations of the hip occurred twice after subcapital osteotomy. Chondrolysis and hip ankylosis were reported in one patient after subcapital osteotomy. DISCUSSION The hypothesis was confirmed because the results of treatment of severe slips without hip dislocation are comparable with procedures using the surgical hip dislocation. The results correspond with large published cohorts of patients in terms of correction as well as the rate of complications. CONCLUSIONS The best results were achieved by closed reduction of acute slips where no complications were present. Subcapital osteotomy without surgical dislocation is comparable with modified osteotomy with surgical hip dislocation. Intertrochanteric osteotomy represents an efficient method in treating grade II slips. Transphyseal fixation without slip correction cannot be recommended in treating severe slips. Key words: slipped capital femoral epiphysis, severe grades of slip, subcapital femoral osteotomy, intertrochanteric femoral osteotomy, closed reduction of slip.
- MeSH
- časové faktory MeSH
- dítě MeSH
- lidé MeSH
- luxace kyčle * chirurgie MeSH
- následné studie MeSH
- osteotomie MeSH
- skluz proximální femorální epifýzy * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Various surgical treatments for osteoarthritis (OA) secondary to hip dysplasia have been reported in the literature. According to the position of the arthroplasty cup, generally they could be divided into two groups: the primary rotational center (PRC) group and the high hip center (HHC) group. Some surgeons prefer the HHC technique. Without doubt it is less demanding, but several concerns exist against the long-term stability. When restoring the PRC, since the dysplastic acetabulum is usually shallower and underdeveloped, bone grafts or other biosynthetic materials are usually needed for the ideal fixation. The source of grafts is quite wide. For example, they could be autologous (femoral head, iliac crest) or homologous (allografts), bulky or morselized. Medial wall protrusion technique, as well as other materials like oblong cup, porous titanium and tantalum augments, 3D printed implants could also be an option. Except these, reports are also divided into cemented and cementless techniques. Therefore, no technique is perfect and clinical results so far are quite variable. We think it's necessary to compare the pros and cons between each other. Key words:hip dysplasia, total hip replacement, cup position, secondary osteoarthritis.
