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The pelvic support osteotomy: indications and preoperative planning.

Pafilas D, Nayagam S - Strategies Trauma Limb Reconstr (2008)

Bottom Line: 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.We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure.(b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level?

View Article: PubMed Central - PubMed

Affiliation: Royal Liverpool University and Royal Liverpool Children's Hospitals NHS Trusts, Eaton Road, Liverpool, L12 2AP, UK.

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?

No MeSH data available.


Related in: MedlinePlus

Hunka described five types of sequelae from neonatal septic arthritis: 1 minimal or no femoral head changes; 2A femoral head deformity but physis intact; 2B femoral head deformity with physis closed; 3 femoral neck pseudoarthrosis; 4A complete destruction of femoral head but stable neck segment; 4B complete destruction of femoral head but unstable neck segment; 5 complete destruction of head and neck with dislocation
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Fig2: Hunka described five types of sequelae from neonatal septic arthritis: 1 minimal or no femoral head changes; 2A femoral head deformity but physis intact; 2B femoral head deformity with physis closed; 3 femoral neck pseudoarthrosis; 4A complete destruction of femoral head but stable neck segment; 4B complete destruction of femoral head but unstable neck segment; 5 complete destruction of head and neck with dislocation

Mentions: The sequelae for neonatal septic arthritis has been classified by Hunka et al. [6] (Fig. 2). Whilst the less severely affected varieties of types I to III are amenable to the more usual hip reconstruction procedures (either pelvic or femoral osteotomies or both), types IV and V, in which a greater part of the true hip is destroyed are, in effect, ‘pseudoarthroses’. A similar picture is seen in unsuccessfully treated or neglected cases of congenital dislocation of the hip and after a Girdlestone arthroplasty. In these scenarios the joint is unstable, allowing proximal migration of the femur on loading. This position weakens the action of the gluteal abductors through a shortening of the lever arm and produces the Trendelenburg gait [7]. The limp, although initially painless, becomes painful and walking tolerance decreases [7, 8] (Table 1).Fig. 2


The pelvic support osteotomy: indications and preoperative planning.

Pafilas D, Nayagam S - Strategies Trauma Limb Reconstr (2008)

Hunka described five types of sequelae from neonatal septic arthritis: 1 minimal or no femoral head changes; 2A femoral head deformity but physis intact; 2B femoral head deformity with physis closed; 3 femoral neck pseudoarthrosis; 4A complete destruction of femoral head but stable neck segment; 4B complete destruction of femoral head but unstable neck segment; 5 complete destruction of head and neck with dislocation
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2553427&req=5

Fig2: Hunka described five types of sequelae from neonatal septic arthritis: 1 minimal or no femoral head changes; 2A femoral head deformity but physis intact; 2B femoral head deformity with physis closed; 3 femoral neck pseudoarthrosis; 4A complete destruction of femoral head but stable neck segment; 4B complete destruction of femoral head but unstable neck segment; 5 complete destruction of head and neck with dislocation
Mentions: The sequelae for neonatal septic arthritis has been classified by Hunka et al. [6] (Fig. 2). Whilst the less severely affected varieties of types I to III are amenable to the more usual hip reconstruction procedures (either pelvic or femoral osteotomies or both), types IV and V, in which a greater part of the true hip is destroyed are, in effect, ‘pseudoarthroses’. A similar picture is seen in unsuccessfully treated or neglected cases of congenital dislocation of the hip and after a Girdlestone arthroplasty. In these scenarios the joint is unstable, allowing proximal migration of the femur on loading. This position weakens the action of the gluteal abductors through a shortening of the lever arm and produces the Trendelenburg gait [7]. The limp, although initially painless, becomes painful and walking tolerance decreases [7, 8] (Table 1).Fig. 2

Bottom Line: 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.We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure.(b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level?

View Article: PubMed Central - PubMed

Affiliation: Royal Liverpool University and Royal Liverpool Children's Hospitals NHS Trusts, Eaton Road, Liverpool, L12 2AP, UK.

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?

No MeSH data available.


Related in: MedlinePlus