No abstract

The pelvic support osteotomy is a double level femoral osteotomy with the objective of eliminating a Trendelenburg and short limb gait in young patients with severe hip joint destruction as a consequence of neonatal septic arthritis. The osteotomy has seen several changes and a brief historical overview is provided to set the evolution of the modifications of the procedure in context. We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure. Specifically, we set out to answer the following questions: (a) Where should the first osteotomy be performed and what is the magnitude of valgus and extension correction desired at this level? (b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level?

Inadequate elbow extension is a recognized sequela after obstetric brachial plexus injury because of muscle imbalance and adversely affects the ability to perform sufficiently most daily living activities. The various methods that have been used to correct this deformity do not offer a satisfactory outcome in the long term and show a tendency for gradual recurrence. We present a new technique of a closed gradual arthrodiatasis using a unilateral hinged elbow external fixator. The technique was applied in 10 patients with elbow flexion contracture as a sequela of brachial plexus birth palsy. Loss of elbow extension measured 55 degrees at average. With a mean device application of 8.8 weeks all patients gained full elbow extension. No major complications were noted. All patients were satisfied with the outcome. This novel technique (closed gradual arthrodiatasis of the elbow joint) has a definite role in the treatment of elbow flexion contracture in late cases of obstetric palsy, given the otherwise limited surgical options.