Anteromedial Wedge Reduction Osteotomy for the Treatment of Femoral Head Deformities

Burian, Michal; Dungl, P; Naňka, Ondřej; Chomiak, J; Ošťádal, Martin; Frydrychová, M; Kubeš, R

doi:10.5301/hipint.5000017

Cited by 6 publications

(10 citation statements)

References 22 publications

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“…In more severe cases (especially in hip type IV), previous treatment with overhead extension for about two to three weeks may become indicated. 21 After plaster application the corrected hip position is checked by various imaging procedures e.g. MRI examination.…”

Section: Introductionmentioning

confidence: 99%

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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PurposeIn this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type.MethodsThe development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD).ResultsIn all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated.ConclusionRadiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia.Level of evidence:IV

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Section: Introductionmentioning

confidence: 99%

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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“…At a mean follow-up of 17 months, the Harris hip score had improved significantly (55.4 pre-op to 84.8 post-op). No patients sustained osteonecrosis and all improved in their radiographic Stulberg classification [8].…”

Section: Discussionmentioning

confidence: 91%

Proximal Femoral Osteotomies in Residual Childhood Disease

Barlow

Bittersohl

Schmitz

et al. 2014

Hip Arthroscopy and Hip Joint Preservation Surgery

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The proximal femoral osteotomy is an instrumental tool for hip deformity correction. The goal of a proximal femoral osteotomy is to return the patients' abnormal morphology to an anatomic alignment of the proximal femur. Proximal femoral osteotomy has also been used to change the otherwise normal proximal femoral anatomy in such a way to positively benefit the hip joint through improved mechanics as well as correct global femoral malrotation.Proximal femoral osteotomy has been used to address problems such as severe slipped capital femoral epiphysis disease, Legg-Calvé-Perthes disease, developmental dysplasia of the hip, congenital malrotation, and posttraumatic malunion of the proximal femur.The decision to operate with a proximal femoral osteotomy is driven by patient symptoms in conjunction with altered proximal femoral anatomy and alignment. Plain radiographs and long leg alignment imaging are the key diagnostic imaging techniques when planning a proximal femoral osteotomy. The indications for surgical intervention are poorly defined by previous literature and require a complete assessment of the patient's symptoms and diagnostic imaging.Recently there has been renewed interest and development of new techniques of proximal femoral osteotomy to more directly address pathoanatomy. Focused research on the vascular supply to the femoral head has provided the opportunity to directly treat hip deformity that previously would have been left to natural history and inevitable coxarthrosis [1]. While these new techniques have engendered considerable interest, the long-term outcomes are not available at this point. The techniques described in the following chapter are among the most technically challenging in all of orthopedic surgery.

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“…This altered the anatomy of the femoral neck. In a study by Burian et al 18 , the anterolateral approach was used and periosteum on the anterior aspect of the neck was incised. However, the wedge resection in this study was different from previous studies.…”

Section: Discussionmentioning

confidence: 99%

Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report

Kim

Han²,

Choy³

et al. 2018

Journal of Pediatric Orthopaedics B

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This research focuses on femoral head wedge resection for the treatment of avascular necrosis (AVN) of the femoral head. A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident. After 8 months of internal fixation using cannulated screws for Delbet-type 2 fracture of the femoral neck, AVN of the femoral head developed in the patient. Even though valgus-derotation-extension intertrochanteric osteotomy was performed for the treatment of AVN, it progressed further and femoral head wedge resection was performed to recover the femoral head sphericity. After 3 years of follow-up, radiograph results showed appropriate and satisfactory congruency and containment. This research shows that the treatment of AVN of the femoral head using femoral head wedge resection is an effective method that can yield excellent results.

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Anteromedial Wedge Reduction Osteotomy for the Treatment of Femoral Head Deformities

Cited by 6 publications

References 22 publications

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Proximal Femoral Osteotomies in Residual Childhood Disease

Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report

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