Outcomes of Direct Infrapectineal Buttress Plate for Quadrilateral Surface Fractures of Acetabulum Using an Anterior Intrapelvic Approach / 대한고관절학회지

Purpose@#Reduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach. @*Materials and Methods@#We conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d’Aubigné score. @*Results@#The current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22-62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time. @*Conclusion@#Quadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes.

One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age / 대한고관절학회지

PURPOSE: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). MATERIALS AND METHODS: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). RESULTS: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. CONCLUSION: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

Selection of lowest instrumented vertebra in the management of lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation

Objective: To determine the lowest instrumented vertebra [LIV] in the management of Lenke 5 adolescent idiopathic scoliosis [AIS] patients using pedicle screw instrumentation. [PSI]

Study design: A retrospective review

Place and Duration of study: Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, from January 2014 to April 2016

Methodology: Analysis of radiographic parameters of 32 patients was done. The patients were grouped according to the LIV level; Group I [fusion to L3, n=25] and Group II [fusion to L4, n=7]. The Group I was further subdivided into IA [L3 crossed the mid-sacral line with rotation of less than grade II on bending films - n=14] and IIB [L3 did not cross the mid-sacral line or rotation was grade II or more on bending films n=11]. All the patients in the Group II had the same location and rotation of L3 in bending films as that of patients in the group IB. Patients with lowest instrumented vertebral tilt [LIVT] of more than 10[degree] or coronal balance of more than 15 mm, were considered to have unsatisfactory results

Results: LIVT was reduced from 20.8 +/- 6.3 to 5.5 +/- 2.9[degree] in group IA and from 24.1 +/- 8.2[degree] to 10.8 +/- 5.1[degree] in group IB and from 26.7 +/- 4.6 to 6.9 +/- 5.2[degree] in group II. A significantly less reduction was obtained in group IB [49.7%] as compared to group IA [88.4%] and group II [81.8%]. Unsatisfactory results were obtained in 1 [7.1%] patient of group IA, in 7 [63.3%] patients of the group IB, and in 1 [12.5%] patient of group II which was found to be statistically significant

Conclusions: For the correction of thoracolumbar / lumbar AIS with pedicle screw instrumentation, L3 can be selected as the LIV instead of L4, thus saving one distal motion segment, when preoperatively L3 crosses the midsacral line with a rotation of less than Nash-Moe grade II in both the active bending radiographs, otherwise fusion has to be extended to L4