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Management of late onset perthes: evaluation of distraction by external fixator-5-year follow-up.

Singh A, Srivastava RN, Shukla P, Pushkar A, Ali S - Adv Orthop (2014)

Bottom Line: There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant.There was significant improvement in Harris Hip score.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, King George's Medical University, Lucknow 226018, India.

ABSTRACT
Background. Hip distraction in Perthes' disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. Methods and Materials. Twelve children with age more than 8 years with Perthes' disease of less than one year were treated with hip distraction by a hinged monolateral external fixator. Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score. Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes' disease in the selected group of patients, where poor results are expected from conventional treatment.

No MeSH data available.


Related in: MedlinePlus

A 10.2-year-old female patient with Perthes' disease for the last eight months. (a) Managed with hinged monolateral external fixator, showing increased sclerosis of epiphysis with maintaining the epiphyseal height (b). At 1-year follow-up further collapse of epiphysis with osteolysis (c) was evident, which was resolved by last follow-up at 33.4 months with improved epiphyseal index (d).
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fig1: A 10.2-year-old female patient with Perthes' disease for the last eight months. (a) Managed with hinged monolateral external fixator, showing increased sclerosis of epiphysis with maintaining the epiphyseal height (b). At 1-year follow-up further collapse of epiphysis with osteolysis (c) was evident, which was resolved by last follow-up at 33.4 months with improved epiphyseal index (d).

Mentions: The mean epiphyseal index measured at the end of 24 months was significantly improved from 0.69 to 0.75 (P = 0.005). It could not be established whether any epiphyseal collapse would have occurred if the arthrodiastasis had been avoided due to short follow-up. During the follow-up, the change in the percentage of uncovered head was insignificant in this study. The appearance of osteolysis around the dead bone was reduced in all patients. During the treatment, four patients developed the pin tract infection, which was controlled by local dressing and antibiotics. No case of implant failure or stress fracture was seen. At the last follow-up, Harris Hip score improvement was observed from 56 to 86, which was significant. As yet, it is too early for all the patients to be given a grading according to Stulberg et al. [14], as that can be done only at skeletal maturity (Figures 1 and 2).


Management of late onset perthes: evaluation of distraction by external fixator-5-year follow-up.

Singh A, Srivastava RN, Shukla P, Pushkar A, Ali S - Adv Orthop (2014)

A 10.2-year-old female patient with Perthes' disease for the last eight months. (a) Managed with hinged monolateral external fixator, showing increased sclerosis of epiphysis with maintaining the epiphyseal height (b). At 1-year follow-up further collapse of epiphysis with osteolysis (c) was evident, which was resolved by last follow-up at 33.4 months with improved epiphyseal index (d).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279912&req=5

fig1: A 10.2-year-old female patient with Perthes' disease for the last eight months. (a) Managed with hinged monolateral external fixator, showing increased sclerosis of epiphysis with maintaining the epiphyseal height (b). At 1-year follow-up further collapse of epiphysis with osteolysis (c) was evident, which was resolved by last follow-up at 33.4 months with improved epiphyseal index (d).
Mentions: The mean epiphyseal index measured at the end of 24 months was significantly improved from 0.69 to 0.75 (P = 0.005). It could not be established whether any epiphyseal collapse would have occurred if the arthrodiastasis had been avoided due to short follow-up. During the follow-up, the change in the percentage of uncovered head was insignificant in this study. The appearance of osteolysis around the dead bone was reduced in all patients. During the treatment, four patients developed the pin tract infection, which was controlled by local dressing and antibiotics. No case of implant failure or stress fracture was seen. At the last follow-up, Harris Hip score improvement was observed from 56 to 86, which was significant. As yet, it is too early for all the patients to be given a grading according to Stulberg et al. [14], as that can be done only at skeletal maturity (Figures 1 and 2).

Bottom Line: There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant.There was significant improvement in Harris Hip score.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, King George's Medical University, Lucknow 226018, India.

ABSTRACT
Background. Hip distraction in Perthes' disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. Methods and Materials. Twelve children with age more than 8 years with Perthes' disease of less than one year were treated with hip distraction by a hinged monolateral external fixator. Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score. Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes' disease in the selected group of patients, where poor results are expected from conventional treatment.

No MeSH data available.


Related in: MedlinePlus