Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes' disease.

Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.;

The effect of pediatric orthopaedic experience on interobserver and intraobserver reliability of the herring lateral pillar classification of Perthes disease.

An analysis was done of the effect of surgeons' pediatric orthopaedic experience on the classification of Perthes disease according to the lateral pillar classification described by Herring. Five observers with varied pediatric orthopaedic experience reviewed anteroposterior (AP) pelvis radiographs of 33 patients in the fragmentation phase of Perthes disease and classified each case on three separate occasions at least 24 hours apart. Frog-leg lateral-view radiographs taken at the same time were also classified using the same criteria based on the femoral head anterior column. Kappa statistics showed good agreement for intra- and interobserver reliability of classification for both AP and frog lateral radiographs. There were no statistically significant variations among the reviewers. Twenty-four percent of the cases had a classification one grade worse on the lateral radiograph compared to the AP view. The lateral pillar classification provides a reproducible radiographic technique for Perthes disease characterization independent of pediatric orthopaedic experience.

Evaluation of process fractures of the talus using computed tomography.

Coronal computed tomography (CT) scan was used in the evaluation of a fractured process of the talus in 10 patients. Because routine radiographs failed to determine either the size or comminution of the fractured process, CT imaging was used to accurately assess the size, displacement, and comminution of the fractured process. CT scans also showed the extent of subtalar joint involvement, any associated tendon pathology, or additional fractures. In two patients the nature of the injury was initially missed, and CT scan diagnosed a nonunion of the lateral process. In all patients, CT scan altered the management of the fracture or helped in selecting the surgical approach. The authors recommend that coronal CT scans be used in the evaluation of a fractured process of the talus.

Medial subtalar dislocation associated with fracture of the posterior process of the talus. A case report.

A 27 year-old man was involved in a high-energy-impact motor-vehicle accident and sustained multiple injuries including a medial subtalar fracture dislocation. The dislocation of the subtalar joint was reduced by closed means, but a large, comminuted, displaced posterior process fracture remained. Open reduction and internal fixation through a posteromedial approach with mobilization of the neurovascular bundle was used to restore congruity to the subtalar joint.