Radiological evaluation of combined valgus extension osteotomy and tectoplasty for the treatment of Herring group C Perthes patients.

OBJECTIVES: In this study we evaluated the results of combined proximal femoral valgus extension osteotomy and tectoplasty in the treatment of Herring group C Perthes disease with hinge abduction. PATIENTS AND METHODS: This study was carried out in 11 male patients who underwent combined proximal femoral valgus extension osteotomy and tectoplasty for hinge abduction related to Perthes disease between January 2002 and February 2009. All patients were assessed as group C according to the Herring lateral pillar classification. The mean age at the time of surgery was nine years and one month with an age range of six years to 11 years and two months. All patients had pain and hinge abduction preoperatively. RESULTS: The mean follow-up was 65 months (range 26 to 111 months). In the patients who received a proximal valgus extension osteotomy and tectoplasty, the postoperative femoral head containment was significantly increased radiographically. The postoperative femoral head containment was evaluated on radiographs which were taken one and three months after the surgery. After healing of the osteotomy, one-year and final control graphies were evaluated. We carried out a comprehensive evaluation of preoperative and postoperative radiographs that included measuring; subluxation ratio, femoral head coverage ratio, femoral head size ratio, Sharp's angle, CE (center-edge) angle, neck-shaft angle, caput index and acetabular depth index. Consequently there were significant radiographic healing and improvements from time of initial follow-up to final follow-up. CONCLUSION: This study has shown that, in the short-term, combined valgus extension osteotomy and tectoplasty relived pain and corrected deformity in patients with hinge abduction. As growth continues the remodelling of hip joint is influenced in a positive way.

MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor.

OBJECTIVE: To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. MATERIALS AND METHODS: Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal multiplanar reconstruction images in consensus. MDCT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed. RESULTS: Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement. CONCLUSION: MDCT with multiplanar reconstruction is an accurate technique in the preoperative local staging of rectal tumor.