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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

Schematic representation of relationships between the pelvis, knee and femur in bipedal and single limb stance. a In bipedal stance with the feet at shoulder’s width, the knee joint is at slight valgus to the horizontal plane (3º). Both knees are equidistant to the midline vertical axis (x1 = x2). b In single stance, the knee and ankle joint of the weight-bearing limb are horizontal and parallel to the pelvic line. This is accomplished through a slight adduction at the hip. The femoral shaft subtends an angle of 9º to the midline vertical axis. The ground reaction force moves closer to the standing leg, x1 ≠ x2
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Fig4: Schematic representation of relationships between the pelvis, knee and femur in bipedal and single limb stance. a In bipedal stance with the feet at shoulder’s width, the knee joint is at slight valgus to the horizontal plane (3º). Both knees are equidistant to the midline vertical axis (x1 = x2). b In single stance, the knee and ankle joint of the weight-bearing limb are horizontal and parallel to the pelvic line. This is accomplished through a slight adduction at the hip. The femoral shaft subtends an angle of 9º to the midline vertical axis. The ground reaction force moves closer to the standing leg, x1 ≠ x2

Mentions: In standing (bipedal stance) the pelvis is level if both limbs are equal in length and contractures absent in any of the lower limb joints. With the feet at shoulder’s width, the knee joint subtends a slight valgus inclination to the horizontal (3°). Several changes occur in single stance of gait. The weight-bearing limb becomes slightly adducted to the vertical (about 3°); in so doing the knee joint inclination is horizontal and parallel to the ground (Fig. 4a) [19]. Bodyweight remains roughly in the midline and produces a moment that tends to drop the pelvis slightly on the unsupported side—this is countered by the action of the hip abductor muscles [20]. It is this position of the pelvis and of the weight-bearing limb in single stance that serves as a reference in planning for a pelvic support osteotomy. Therefore a horizontal lie to the pelvis with the knee and ankle joint inclinations parallel to it and to the ground are the reference positions. Through using the standard reference angles, the femoral shaft will be 9° to a vertical axis when the limb and pelvis are in this position (Fig. 4b).Fig. 4


The pelvic support osteotomy: indications and preoperative planning.

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

Schematic representation of relationships between the pelvis, knee and femur in bipedal and single limb stance. a In bipedal stance with the feet at shoulder’s width, the knee joint is at slight valgus to the horizontal plane (3º). Both knees are equidistant to the midline vertical axis (x1 = x2). b In single stance, the knee and ankle joint of the weight-bearing limb are horizontal and parallel to the pelvic line. This is accomplished through a slight adduction at the hip. The femoral shaft subtends an angle of 9º to the midline vertical axis. The ground reaction force moves closer to the standing leg, x1 ≠ x2
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2553427&req=5

Fig4: Schematic representation of relationships between the pelvis, knee and femur in bipedal and single limb stance. a In bipedal stance with the feet at shoulder’s width, the knee joint is at slight valgus to the horizontal plane (3º). Both knees are equidistant to the midline vertical axis (x1 = x2). b In single stance, the knee and ankle joint of the weight-bearing limb are horizontal and parallel to the pelvic line. This is accomplished through a slight adduction at the hip. The femoral shaft subtends an angle of 9º to the midline vertical axis. The ground reaction force moves closer to the standing leg, x1 ≠ x2
Mentions: In standing (bipedal stance) the pelvis is level if both limbs are equal in length and contractures absent in any of the lower limb joints. With the feet at shoulder’s width, the knee joint subtends a slight valgus inclination to the horizontal (3°). Several changes occur in single stance of gait. The weight-bearing limb becomes slightly adducted to the vertical (about 3°); in so doing the knee joint inclination is horizontal and parallel to the ground (Fig. 4a) [19]. Bodyweight remains roughly in the midline and produces a moment that tends to drop the pelvis slightly on the unsupported side—this is countered by the action of the hip abductor muscles [20]. It is this position of the pelvis and of the weight-bearing limb in single stance that serves as a reference in planning for a pelvic support osteotomy. Therefore a horizontal lie to the pelvis with the knee and ankle joint inclinations parallel to it and to the ground are the reference positions. Through using the standard reference angles, the femoral shaft will be 9° to a vertical axis when the limb and pelvis are in this position (Fig. 4b).Fig. 4

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