ABSTRACT
Severe unstable slipped capital femoral epiphysis (SCFE) usually requires some form of reduction before stabilization to avoid loss of motion and to prevent the development of early degenerative arthritis. Gentle manipulation and traction is being used to achieve reduction. The force applied with these techniques is uncontrolled and unpredictable, and may add to the pre-existing risk of avascular necrosis of the femoral head in such cases. The authors report a case of acute on chronic, severe, unstable SCFE in which reduction was satisfactorily achieved by gradual distraction using an external fixator across the hip joint. The patient did not show signs of avascular necrosis or chondrolysis at a follow-up of 38 months. Hip function was excellent with Iowa hip score of 98 at the final follow-up.
Subject(s)
Cartilage, Articular/surgery , Epiphyses, Slipped/surgery , External Fixators , Femur , Osteogenesis, Distraction/methods , Cartilage, Articular/pathology , Child , Epiphyses, Slipped/complications , Epiphyses, Slipped/pathology , Female , Femur Head Necrosis/etiology , Femur Head Necrosis/pathology , Femur Head Necrosis/surgery , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Radiography , Treatment OutcomeABSTRACT
BACKGROUND: In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods. PATIENTS AND METHODS: We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients. RESULTS: The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening. INTERPRETATION: The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening
