A COMPREHENSIVE PELVIC AND FEMORAL OSTEOTOMY REVISION TO TREAT A FAILED PELVIC AND FEMORAL OSTEOTOMY: A CASE REPORT

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent. The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.

How does former Salter innominate osteotomy in patients with Legg–Calvé–Perthes disease influence acetabular orientation? An MRI-based study

ABSTRACT Salter innominate osteotomy (SIO) has been successfully used in the treatment of Legg–Calvé–Perthes disease (LCPD). Recent studies that have raised concerns about acetabular retroversion after SIO have been based on plain radiographs. In order to assess the true acetabular orientation, the present study uses a specific magnetic resonance imaging (MRI) technique. In addition, the association between acetabular morphology and clinical function as well as health-related quality of life was assessed. Twenty-three patients with 24 operated hips who underwent SIO for LCPD between January 2004 and November 2014 were included. Mean age was 8.5 ± 2.2 years at surgery and 18.5 ± 2.9 years at follow-up. MRIs were conducted at 1.5 T using radial sequences. The analysis included the acetabular version, acetabular sector angles (ASAs) and alpha angles. Plain radiographs were used in order to obtain the Stulberg classification. Patient-related outcome measures included the international Hip Outcome Tool and Euroqol-5 dimensions scores. In comparison to the non-operated side, the MRI of previously operated hips showed no difference of version at the center of the femoral head but significantly decreased version just below the roof level. As a marker for posterior acetabular coverage, the ASAs between 9 and 11 o’clock were significantly decreased when compared with non-operated hips. In hips with a mild acetabular retroversion (<15°), the function was significantly decreased when compared with non-retroverted hips. The SIO is an effective tool in order to restore acetabular containment in LCPD. When compared with the non-operated hips, our collective displays only moderate changes of acetabular orientation and coverage.

Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

A Rare Case of an Iliac Fracture at the Iliac Fossa Immediately after Salter Innominate Osteotomy

This report presents the unusual case of a 5-year-old girl with iliac fracture just after Salter innominate osteotomy for developmental dysplasia of the hip. The iliac fracture was diagnosed two days after Salter innominate osteotomy, and computed tomography (CT) revealed that it was at the extremely thin portion of the iliac wing called the “iliac fossa.” We were able to reduce the fracture by pulling the left leg distally, and after reducing the iliac bone, the ilium was fixed by Kirschner wire from the anteroinferior iliac spine and anterosuperior iliac spine. The patient was in a hip-spica cast for 6 weeks postoperatively and allowed to walk from 3 months after the surgery. At the last follow-up one year after the surgery, bone union was completely obtained, and she had no complications. The cause of the fracture seems to be the stress concentration on the iliac fossa due to the cranked iliac osteotomy line passing through the iliac fossa. The current case indicates the importance of careful evaluation by CT before surgery and ensuring that the osteotomy line does not extend near the iliac fossa.

Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review (Preprint)

BACKGROUND Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. OBJECTIVE The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. METHODS An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. RESULTS A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. CONCLUSIONS This review provides clinicians with a brief guideline for the treatment of patients with LCPD.