101 research outputs found
Electrophysiologic evaluation of neuromuscular functions during limb lengthening by callus distraction
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Surgical Treatment of Severe Perthsdisease:Comparision of Tripleosteotomy and Shelf Augmentation
No full textThe optimal management of the severe form of Perthes disease is a controversial . This retrospective study evaluated the results of two procedures in two groups of patients. The Catterall classification was adopted for grouping of patients before treatment. The Herring classification was used for comparison of the follow-up radiographs. Under the concept of surgical containment, triple innominate osteotomy was performed in 14 patients at an average age of 8 years 7 months with a mean follow-up period of 4 years 3 months. Staheli's shelf augmentation was performed in 14 patients at an average age of 10 years 2 months with a follow-up period of 3 years 8 months. Radiologically, femoral head subluxation, acetabular coverage, acetabular angle, and center-edge angle were significantly improved in both groups . In the clinical evaluation using modified Sundt's criteria , both procedures were effective. Satisfactory results could be achieved in 79 % of 14 patient (5 good, 6 fair and 3 poor) in the triple osteotomy group, and 100 % of 14 patient (2 good, 12 fair) in the shelf augmentation group. Nevertheless, triple innominate osteotomy is more technically demanding with longer operative time and higher complications. Staheli's shelf augmentation is a simpler procedure with better coverage of the acetabulum. However, asphericity of the femoral heads was observed more frequently in this group. The Herring 's lateral pillar classification was better than the Catterall classification in the predicting the final outcomes in this study
Reconstruction for Sequelae of Septic Hip in Children
No full textSequelae of septic hip in children may develop either due to inadequate management or neglect in the acute stage. We treated 13 patients (13 hips) with late sequelae of septic hip by reconstruction procedures, from 1985 to 1992. The mean age of the patients was 6.1yeears. Their initial bony deformities were all beyond the Hunka's classification type IIB. All of them had problems of hip instability and leg length discrepancy. With the intention to reestablish containment of the hip joint, open reduction, femoral osteotomy and pelvic osteotomy were performed. Four patients , all beyond Hunka type IV, had secondary surgery for hip resubluxation. Leg length discrepancies were corrected by valgus osteotomy and limb lengthening. At an average follow- up of 6.3years, all remodeled hips were stable. Early reconstruction is recommended to stabilize the hip joint and restore the normal hip center for bone development. The leg length discrepancies were corrected by an Ilizarov limb lengthening procedure at a later stage
Increasing Nail-Cortical Contact to Increase Fixation Stability and Decrease Implant Strain in Antegrade Locked Nailing of Distal Femoral Fractures: A Biomechanical Study
No full textBackground: Proximity of the distal locking screw to the fracture site potentially can cause implant failure in locked nailing of distal femoral fractures. In this biomechanical study, we investigated the effects of nail- cortical contact and nail purchase in the distal subchondral bone on fixation stability and implant strain. Methods: Using fiberglass artificial femurs, we fixed five different distal femoral osteotomies with specially manufactured locked nails representing different conditions of nail- cortical contact. In each condition, six femur-nail constructs were loaded on the femoral head axially with 700 N; then we measured the fixation stability and strain at the superiormost distal locking screw and nail hole. The tests were conducted both with and without nail purchase in distal subchondral bone. Results: When there was no nail-cortical contact, the load transmitted to the distal femoral fragment was completely borne by the nail and the distal locking screws. Low fixation stability and high strain on the distal screw and nail hole resulted. Greater nail-cortical contact increased the fixation stability and decreased strains on the distal screw and nail hole. Purchase of the nail tip in distal subchondral bone significantly increased the fixation stability and decreased nail hole strain except in the situation of long nail-cortical contact. The screw strain was significantly reduced in all conditions, and the reduction in strain was significantly greater than that associated with the nail hole, 32% +/- 8% versus 15.7% +/- 2 .5% (p = 0.002). Conclusion: In locked nailing of distal femoral fractures, the prime factor determining fixation stability and implant strain is nail- cortical contact. In situations without nail-cortical contact, a longer nail with purchase in the subchondral bone of the distal femur is recommended
Age and height effects on the center of mass and center of pressure inclination angles during obstacle-crossing
No full textTypes of Neglected Developmental Dysplasia of the Hip (Ddh) in Skeletally Mature Patients
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