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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

The second osteotomy removes the ‘abduction contracture’ and allows both limbs to be parallel, with the knee, ankle and the pelvis horizontal. The treated side remains in maximum adduction at its articulation with the pelvis, and therefore prevents a Trendelenburg gait. Lengthening at the second osteotomy removes limb length inequality
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Fig6: The second osteotomy removes the ‘abduction contracture’ and allows both limbs to be parallel, with the knee, ankle and the pelvis horizontal. The treated side remains in maximum adduction at its articulation with the pelvis, and therefore prevents a Trendelenburg gait. Lengthening at the second osteotomy removes limb length inequality

Mentions: This second osteotomy is Ilizarov’s contribution to the pelvic support technique that addresses the excessive valgus of the proximal osteotomy and allows for derotation (if not done proximally) and lengthening as well (Fig. 6). Some authors have advocated the distal osteotomy be performed at the intersection of two lines: a vertical axis that is dropped from the horizontal line of the pelvis which traverses through the proximal osteotomy site and the mechanical axis of the tibia extrapolated proximally [14, 17, 22]. Using the method of the intersecting axes, the site of the distal osteotomy will vary depending on the amount of valgus overcorrection introduced; similarly, it will also vary if the position of the proximal osteotomy is in line with the medial edge of the ischial tuberosity as compared with its lateral edge. This imparts some variability to the final position of limb in reference to the midline of the body. If the osteotomy is performed too proximally it can medialise the entire limb and vice versa. Although a restoration of the mechanical axis is put forward as the reason to perform the second femoral osteotomy according to the intersection of axes above, it is assumed that the ‘centre of the joint’ of the new femoral—pelvic articulation is at the point of contact of the first osteotomy to the pelvis. We do not believe this to be true as, in the coronal plane, when the limb is abducted the axis of rotation lies further lateral to this point. Furthermore this axis of rotation is different in the sagittal plane and does not coincide with that in the coronal. This variation is a reflection that we no longer have a ‘joint’ in the normal meaning and a false articulation. With the standard definition of a mechanical axis, which is a line drawn from the centre of one joint to the centre of the next joint, we are unable to apply it in this setting satisfactorily.Fig. 6


The pelvic support osteotomy: indications and preoperative planning.

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

The second osteotomy removes the ‘abduction contracture’ and allows both limbs to be parallel, with the knee, ankle and the pelvis horizontal. The treated side remains in maximum adduction at its articulation with the pelvis, and therefore prevents a Trendelenburg gait. Lengthening at the second osteotomy removes limb length inequality
© Copyright Policy
Related In: Results  -  Collection

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

Fig6: The second osteotomy removes the ‘abduction contracture’ and allows both limbs to be parallel, with the knee, ankle and the pelvis horizontal. The treated side remains in maximum adduction at its articulation with the pelvis, and therefore prevents a Trendelenburg gait. Lengthening at the second osteotomy removes limb length inequality
Mentions: This second osteotomy is Ilizarov’s contribution to the pelvic support technique that addresses the excessive valgus of the proximal osteotomy and allows for derotation (if not done proximally) and lengthening as well (Fig. 6). Some authors have advocated the distal osteotomy be performed at the intersection of two lines: a vertical axis that is dropped from the horizontal line of the pelvis which traverses through the proximal osteotomy site and the mechanical axis of the tibia extrapolated proximally [14, 17, 22]. Using the method of the intersecting axes, the site of the distal osteotomy will vary depending on the amount of valgus overcorrection introduced; similarly, it will also vary if the position of the proximal osteotomy is in line with the medial edge of the ischial tuberosity as compared with its lateral edge. This imparts some variability to the final position of limb in reference to the midline of the body. If the osteotomy is performed too proximally it can medialise the entire limb and vice versa. Although a restoration of the mechanical axis is put forward as the reason to perform the second femoral osteotomy according to the intersection of axes above, it is assumed that the ‘centre of the joint’ of the new femoral—pelvic articulation is at the point of contact of the first osteotomy to the pelvis. We do not believe this to be true as, in the coronal plane, when the limb is abducted the axis of rotation lies further lateral to this point. Furthermore this axis of rotation is different in the sagittal plane and does not coincide with that in the coronal. This variation is a reflection that we no longer have a ‘joint’ in the normal meaning and a false articulation. With the standard definition of a mechanical axis, which is a line drawn from the centre of one joint to the centre of the next joint, we are unable to apply it in this setting satisfactorily.Fig. 6

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