Haste intramedular bloqueada em comparação com placa de compressão dinâmica na estabilização de osteotomia intertrocantérica varizante em cães: estudo ex vivo / Interlocking nail system in comparison with dynamic compression plate in the stabilization of intertrochanteric varus osteotomy in dogs: study in cadavers

Tendo em vista as vantagens das hastes intramedulares bloqueadas (HIB) em relação às placas ósseas na estabilização femoral, o presente estudo objetivou avaliar a exequibilidade e eficácia da aplicação da HIB pós osteotomia intertrocantérica varizante (OIV). Submeteu-se 10 cadáveres caninos à OIV. Nos antímeros esquerdos obteve-se a estabilização por meio de HIB (grupo HIB) e, nos direitos, com placas de compressão dinâmica (grupo placa). Foram comparados os ângulos de Norberg e de inclinação da cabeça e colo femoral (ICF) antes (T0) e após (T1) a OIV. O tempo dispendido para a colocação dos implantes e resultados de resistência biomecânica à compressão e torção também foram confrontados entre os grupos. Houve aumento do ângulo de Norberg entre T0 (106,84®5,55o) e T1 (111,22o®3,89), apenas no grupo HIB (p<0,05). No entanto, redução do ângulo de ICF após OIV (T1) foi observada tanto no grupo placa (T0=127,6®4,70o e T1=110,06®10,61o, p<0,05) quanto no grupo HIB (T0=126,43®5,87o e T1=116,87®8,62o, p<0,05). Os tempos de colocação dos implantes não diferiram estatisticamente e apenas o teste biomecânico de compressão revelou diferença entre os grupos, com maior resistência (P=0,033) do grupo placa (863,3®74,46N/mm) em relação ao grupo HIB (586,7®44,10N/mm). Deste modo, a estabilização por meio de HIB foi factível e eficaz. Embora o resultado biomecânico de compressão tenha demonstrado maior fragilidade da HIB em relação à placa de compressão, seus valores estão acima das forças atuantes, reportadas na literatura, na deambulação normal de cão.(AU)

Considering the advantages of the interlocking intramedullary nail (IN) in relation to bone plates in the femoral stabilization, this study aimed to evaluate the feasibility and effectiveness of IN application post intertrochanteric varus osteotomy (IVO). For this purpose, 10 canines cadavers were used. On the left femurs, the fixation was obtained with IN (IN group) and rights fixed with dynamic compression plates and screws (plate group). Was compared the angles of Norberg and inclination of the head and femoral neck (IHF) before (T0) and after (T1) IVO. The results of time spent for placement of implants and biomechanical resistance to compression and torsion were also confronted between groups. There was an increase of the Norberg angle between T0 (106.84®5.55o) and T1 (111.22o®3.89), only in IN group (p<0.05). However, reduction of IHF angle after IVO (T1) was observed in both, the plate group (T0=127.6®4.70o e T1=110.06®10.61o, p<0.05) and IN group (T0=126.43®5.87o e T1=116.87® 8.62 o, p<0.05). The placement times of the implants did not differ statistically and only the compression biomechanical test revealed differences between groups, with greater resistance (P=0.033) of the plate group (863.3®74.46N/mm) compared to IN group (586.7®44.10N/mm). Thus, stabilization through IN was feasible and effective. Although the compression biomechanical results has demonstrated a higher fragility of IN in relation to the compression plate, their values are above the forces, reported in literature, acting in normal dog gait.(AU)

Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head

BACKGROUND: Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head. METHODS: From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: The TCVO group had shorter operation time (p < 0.05) and less estimated blood loss (p = 0.026). Postoperative collapse developed in 26 hips (28.6%) in the TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group. CONCLUSIONS: The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

PURPOSE: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). MATERIALS AND METHODS: We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group III or IV, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. RESULTS: The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. CONCLUSION: FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.

Intertrochanteric Varus Open Wedge Osteotomyin Legg-Calve-Perthes Disease Patients Older than 9 Years Old / 대한정형외과학회잡지

PURPOSE: To evaluate the outcome of intertrochanteric varus open wedge osteotomy in LCP in patients over 9 years old. MATERIALS AND METHODS: Thirty-three patients over 9 years old, who were diagnosed with LCP were treated by intertrochanteric varus open wedge osteotomies, from August 1989 to August 2002. The mean age of the patients was 10.2 years old (range, 9 to 14 years old), with a mean duration of follow-up of 7.7 years (range, 3.2 to 14.1 years). According to the Harring classification system, there were 3 group A, 21 group B, and 11 group C patients. There were thirty male and three female patient. There were 2 cases of female patients with bilateral extremity involvement of LCP. Radiographic outcome was assessed utilizing Stulberg's classification to grade residual deformities. RESULTS: 10 cases were Stulberg classes I and II (spherically congruent), 15 were classes III and IV (aspherically congruent), and 10 were class V (aspherically incongruent). Less involvement of the disease and treatment in the early stages produced better outcomes. CONCLUSION: Intertrochanteric varus open wedge osteotomy is a reliable treatment for LCP after the age of 9 years old, if the disease is evaluated individually according to the extent and stage of its involvement.

Joelho valgo em cães de pequeno porte - relato de dois casos / Valgus deformity of the stifle joint in small dogs-report of two cases

O joelho valgo é observado primariamente em cães de raças gigantes como resultado da disparidade do crescimento da porção lateral e medial da epífise distal do fêmur, apesar da porção proximal da tíbia poder estar envolvida. As formas de tratamento são: epifisiodese, transecção periosteal invertida em ôTö ou osteotomia corretiva. Descreve-se dois casos de joelho valgo em cães jovens de pequeno porte. À palpação observou-se crepitação e diferentes graus de luxação patelar. O exame radiográfico revelou desvio longitudinal da tíbia com moderado estreitamento do espaço intra-articular medial. O tratamento padrão para ambos os casos foi a ostectomia cuneiforme varizante, seguida de fixação com placa e parafusos. Após a cirurgia, observou-se deambulação normal com remissão dos sinais clínicos, apesar da manutenção da luxação patelar. O relato destes casos prende-se à raridade de tal condição ortopédica em cães de pequeno porte, atentando-se ao fato de que tal afecção pode ser confundida clinicamente com a luxação de patela, a qual não seria corretamente tratada com técnicas tradicionais para estabilização articular.

Femoral Varus Osteotomy Versus Salter Innominate Osteotomy in the Treatment of Legg - Calve - Perthes Disease / 대한정형외과학회잡지

We compared the clinical and radiographic outcomes between femoral varus osteotomy (23 hips) and Salter innominate osteotomy (18 hips) for treatment of Catteral is groups III and IV Perthes disease after 3-12 years follow-up. There were no statistically significant differences in the clinical outcomes using the lowa hip rating score and leg length discrepancy and in the final radiographic outcomes using the femoral head sphericity and Stulberg type between the two groups. However, neckshaft angle and center-edge angle were closer to normal value in the Salter innominate osteotomy group compared with the femoral varus osteotomy group. When the patients underwent femoral varus osteotomy at the older age (7 years), articulotrochanteric distance ratio and neck-shaft angle were significantly less than those of other patients. Salter innominate osteotomy may be better indi- cated as compared to femoral varus osteotomy, when physeal damage of proximal femur is obvious or highly suspicious particularly in the older children (7 years) with severe Perthes disease.

Femoral Varus Osteotomy for Legg - Calve - Perthes Disease in Children Who Are Less Than 5 Years Old / 대한정형외과학회잡지

Because clinical course of the Legg-Calve'-Perthes disease (LCPD) is varied and unpredictable, it is important that pediatric orthopedists have to know prognostic factors of LCPD in order to choose proper method of treatment. The most universally accepted prognostic factor is the patient's age at the onset of the disease, and most patient's who are less than 5 years old have been treated non-operatively. However, we believe that the extent of involvement of the femoral head is more important in this age group and that operative treatment can get good results in cases of servere head involvement. The purpose of this study is to evaluate the efficacy of femoral varus osteotomy in patients before the age of 5 years with severe involvement. We reviewed 18 patients (23 hips) who were less than 5 years old with Catterall group III (5 patients, 7 hips) or IV (13 patients, 16 hips) involvement from June 1984 to June 1994. Femoral varus osteotomies were performed in all cases. We followed up more than 2 years (range, from 24 to 130 months) and analysed clinical and radiological results. The results were as follows: 1. The mean duration from onset of the disease to the stage of repair was 16 months (range, from 8 to 27 months). 2. 2 hips (28.6%) in group III and 12 hips (75%) in group IV showed radiographic head at-risk signs. 3. Clinically all hips in group III showed good result. However, among the 16 hips in group IV, 13 hips were rated good and 3 hips were fair. Overall, 20 hips (86.9%) showed good result. 4. Radiologically all hips in group III showed good result, whereas in group IV, 10 hips were rated good and 6 hips were fair. Overall, 17 hips (78.9%) showed good result. We concluded that femoral varus osteotomy in patients less than 5 years old with severe involvement might shorten the course of disease and might be effective method.

Femoral Osteotomy for Residual Subluxation of Hip after Reduction of Congenital Dislocation / 대한정형외과학회잡지

It is well known that early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip joint to provide a favorable function in the whole life. The goal of treatment, which is either conservative or operative, is to replace the dislocated hip into the socketand restore its anatomical position. If the head is reduced lately, it may subluxate or redislocate. As a result, secondary osteoarthritis will be complicated in such hips at a laterdate The most cases of congenital dislocation of hip have a increased anteversion and vaglus deformity. It is known that these deformity are cause of redislocation or subluxation, and should be corrected by varus or derotational varus osteotomy to restore for normal cephalocotyloid relationship. We analized 18 residual subluxation of hips which had been treated by derotational varus osteotomy. The results obtained are as follows. 1. Regardless of the age at the time of osteotomy and the amount of varization, the neck-shaft angle corrected to nearly normal in all cases within 3 years after the osteotomy. 2. Acetabular development, indicated by acetabular index, was satisfactory when the osteotomy was done before 4 years, but unsatisfactory in the cases after 4 years of age. 3. Coxa valga epiphysialis of the subluxated head corrected spontaenously after osteotomy in all cases. 4. Subluxated head, indicated by C-E angle and migration percentage, reduced in the cases who had by the derotational varus osteotomy in patients below age of 4 years, but it persisted without further luxation in the cases over 4 years of age.

Varus Osteotomy in Subluxated Hip as Sequellae of Healed Tuberculosis in Children: A Case Report / 대한정형외과학회잡지

Subluxation of hip is a disease commonly experienced in orthopaedic field, which is classified into primary subluxation and secondary subluxation. Generally, secondary subluxation of the hip in children who once suffered from infected hips, Legg-Calve-Perths disease and also as sequellae of incompletely treated congenital dislocation of the hip can be often seen in Korea. Especially in Korea, subluxation of the hip with some destruction of the affected femoral head frequently arose from late complication of the tuberculous or septic hip in children. But, no definite treatment for the condition was established and no satisfactory results were obtained with various operative methods. Authors experienced satisfactory result by combining the intertrochanteric varus osteotomy and administration of crystalline glucosamine sulphate (Viatril, Rotta pharmaceuticals, Italy) in subluxated burnt-out tuberculous hip of 6 years old male.