Distal greater trochanteric transfer in the treatment of deformity of the proximal femur caused by avascular necrosis.

Background. Distal greater trochanteric transfer is one of the surgical methods used to correct proximal femoral deformity arising in the course of treatment for developmental dysplasia of the hip. Material and methods. We reviewed a series of 49 patients (55 hips) who had undergone distal greater trochanteric transfer at the mean age of 13.9 years due to deformity of the proximal femur after treatment for developmental dysplasia of the hip, in order to verify the value of the procedure. The mean follow-up was 15 years. Clinical and radiological assessment was supplemented with strain-gauging evaluation of the muscles involved. Results. Good results were achieved in those patients who had good range of movement or isolated restriction of abduction before the operation. After surgery, a 22% increase of abductor torque was found, the Trendelenburg sign disappeared in 30 individuals, and 15 patients regained normal gait. Conclusions. Distal greater trochanteric transfer improved hip joint biomechanics. Good abduction/adduction range of hip movement was essential for clinical improvement and increased muscle strength after surgery. Arthritic changes occurred primarily in those hip joints without clinical improvement. Distal transfer of the greater trochanter delayed osteoarthritis of the hip.

[Long-range outcome in idiopathic scoliosis correction with Cotrel-Dubousset instrumentation]. / Odlegle wyniki leczenia operacyjnego skolioz idiopatycznych metoda Cotrela-Dubousseta.

Background. The purpose of this study is to evaluate outcome in idiopathic scoliosis treated surgically with Cotrel-Dubousset instrumentation. Material and methods. We analyzed the results of surgical treatment of 147 patients with idiopathic scoliosis classified according to King. The mean age of the patients at surgery was 15 years (range 12-25 years), and the mean follow-up was 6.3 years (range 3-12 years). Full-length standing preoperative, postoperative and last follow-up radiographs were studied. Radiographic analysis included the Cobb angle, Risser stage, apical vertebral rotation according to Perdriolle, radiological compensation, T2-T12 kyphosis and L1-S1 lordosis. Results. The greatest scoliosis correction was found in the frontal plane (60% in King IV), much lower in the sagittal. The mean loss of correction was 6.5% thoracic and 10.4% lumbar. In lordoscoliosis, postoperative kyphosis was below the normal range. Apical vertebral derotation ranged from 1 to 5 degrees. Derotation in the thoracic curve correlated with increased rotation in the lumbar curve. Decompensation to the left occurred postoperatively in the majority of patients. At last follow-up, the number of decompensated patients and mean decompensation was smaller. No back pain was found in the majority of patients (78.5%), and they judged the final result of treatment to be excellent (77.5%) or good (20.4%). Complications occurred in 10 patients (6.8%), early infection in 2 cases and late in 3. Conclusions. The greatest correction of scoliosis was found in the frontal plane, less in the sagittal. Small correction of the apical vertebral rotation of the main curve correlated with increased rotation in the secondary curve. The final follow-up decompensation was less than postoperatively.

Rib hump correction in patients with idiopathic thoracic scoliosis treated by the Cotrel-Duboussete method.

Background. This article evaluates correction of rib hump in patients with idiopathic thoracic scoliosis who had been treated by the Cotrel-Dubousette method. Material and methods. We investigated 35 patients pre- and postoperatively in this study. Back surface measurements were studied pre- and postoperatively using our own device. Scoliosis correction was assessed by comparing pre- and postoperative x-rays. Results. We found reduced height, width, length, area of the bottom of the hump, angles of the slope of the humps, surface rotation angle, and difference between hump and depression. Localization of the hump was changed by bringing the top of the hump to the base line (C7-L4) and by displacing the top far from the C7 spinal process. Conclusions. The Cotrel-Dubousette method can be used to correct rib hump and change its localization. Few correlations were found between back surface measurement and radiological outcome.

Correction of thoracic kyphosis and lumbar lordosis in the treatment of idiopathic scoliosis treatment with Cotrel-Dubousset instrumentation.

Background. The treatment of thoracic kyphosis and lumbar lordosis with the C-D method remains controversial. Material and methods. The lateral radiographs of 70 patients with King I, II, III, IV idiopathic scoliosis, treated with C-D instrumentation, were retrospectively analyzed. The average age was 14 +/- 1.8 years. Thoracic kyphosis between T2 and T12 and lumbar lordosis between L1 and L5 were measured. Results. Normalization of thoracic kyphosis occurred in 15 of the 22 hypokyphosis patients. The largest kyphosis correction (average +12 +/- 8 degrees ) was in the preoperative hypokyphosis group. A deep hyperkyphosis (average 64 degrees ) was found preoperatively in patients with postoperative hyperkyphosis. Kyphosis correction in the instrumented region was often reverse to the uninstrumented region correction. Lumbar lordosis remained normal in 29 (63%) and hypolordosis occurred in 14 (31%) of the 45 patients with normal preoperative lordosis. When instrumentation below L1 was performed, a greater decrease in lumbar lordosis was observed. Conclusions. The C-D method enables good kyphosis and lordosis correction in scoliotic patients, but problems may occur in greater deformities. Longer lumbar instrumentation may result in decreased lumbar lordosis.

[Surgical treatment of advanced congenital scoliosis with the C-D method]. / Leczenie operacyjne zaawansowanych skolioz wrodzonych metoda C-D.

The paper presents the results of surgical treatment of 15 cases of congenital scolisios with CD instrumentation. Progression of the deformity was most often seen in cases with combined deformities (according to the McMaster classification). Indications for surgical treatment were progression of the curvature and trunk and thorax deformity progression, particularly during the growth spurt. The age at the time of surgery ranged from 10.3 to 16 years (average: 13.8 years). Follow-up period ranged from 2 to 8 years (average: 4 years). Intraoperative deformity correction ranged from 0 to 60% (average 32%). Loss of correction during follow up ranged from 0 to 3%. The overall silhouette improvement was a result of correction of the spine curvature, correction of thoracic hyperkiphosis and a decrease of trunk decompensation. The only complications noted were 3 cases of transient neurological symptoms from the lower extremities. Preoperative MRI allows detection of congenital deformities of the spinal canal, a contraindication for surgical correction of the deformity with spinal implants.