ABSTRACT
Background: Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH). Objective: A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes. Methods: In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH. Results: The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome. Conclusion: We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.
ABSTRACT
Background: Acromioclavicular joint (ACJ) dislocation and distal clavicle fractures are common shoulder injuries. Different methods of fixation are used to treat such injuries, each has its advantages and disadvantages. In this study, we tested fixation using the hook plate. We think that it is technically simple, reliable and more effective in certain surgical situations. However, it is not gaining adequate popularity due to the potential complications of the plate placement including subacromial osteolysis, impingement, rotator cuff injury and others. A second surgery for plate removal is classically indicated to cope with such complications. Objective: The aim of this study included evaluating the clinical and radiological healing after hook plate fixation in ACJ dislocation and distal clavicle fractures and assessing the incidence and clinical significance of subacromial osteolysis. Methods: It is a prospective observational study with a total of 96 cases including 64 ACJ dislocations and 32 distal clavicle fractures. Constant-Murley score was used for clinical evaluation. The patients were evaluated regularly with a minimum follow up of 12 months after plate removal. Results: At the end of the study we found that the results of the hook plate fixation for both groups were good clinically and radiologically. The clinical result score was found to be initially higher among the patients of the ACJ dislocation mainly due to the earlier plate removal in these patients. However, the final score was found to be comparable in both groups. The incidence of the subacromial osteolysis was found to be higher among the patients with clavicle fractures as the plate was retained for a longer time. However we found that subacromial osteolysis did not imply any increased rate of symptoms over the patients who did not show this complication on the X-ray. Conclusion: Based on these observations, we recommend the hook plate fixation to be added to the armamentarium of the orthopaedic surgeon treating such injuries as it is simple to implement, durable and capable of dealing with difficult situations. The main disadvantage of this method is the need for a second surgery for plate removal.
