ABSTRACT
The influence of the acetabular cover on the development of the proximal femur during the treatment of congenital dysplasia of the hip was studied in 47 children (58 hips) with a follow-up of 22 years. Varus osteotomy failed to correct hip dysplasia in 33 hips of 27 children. Chiari osteotomy was followed by a positive anti-Chiari effect (oval shaped acetabulum with proximal migration of the femoral head) in 15 children (20 hips). In five children (five hips) with coxa vara due to avascular necrosis, the anti-Chiari effect was negative. The combination of Chiari and varus osteotomy before the age of 8 years was followed by a positive anti-Chiari effect and recurrence of valgus deformity in seven of eight hips. The long-term failure of the varus and Chiari osteotomy, together with a review of clinical and experimental surveys, led us to prefer the acetabular redirectional osteotomy.
Subject(s)
Bone Diseases, Developmental/physiopathology , Femur/physiopathology , Hip Dislocation, Congenital/surgery , Osteotomy/methods , Adolescent , Age Factors , Biomechanical Phenomena , Bone Diseases, Developmental/etiology , Child , Child, Preschool , Femur/surgery , Follow-Up Studies , Hip Dislocation, Congenital/complications , Hip Dislocation, Congenital/diagnostic imaging , Humans , Osteotomy/standards , Radiography , Recurrence , RotationABSTRACT
We evaluated 104 osteotomies of the pelvis after an average of 18 years: 48% of patients had hip joint pain, 15% had low back pain, 41% had restricted movement, 74% had a positive Trendelenburg sign, and 77% had limb length discrepancy greater than 1 cm. We also followed the anti-Chiari effect, the influence of the osteotomy on narrowing the birth canal, and deterioration of the opposite acetabulum. We showed that the optimum indications for Chiari osteotomy are severe instability of the hip joint and an irregular femoral head.
Subject(s)
Hip Dislocation, Congenital/surgery , Osteotomy/methods , Pain/epidemiology , Postoperative Complications/epidemiology , Adolescent , Adult , Biomechanical Phenomena , Child , Child, Preschool , Female , Follow-Up Studies , Hip Dislocation, Congenital/diagnostic imaging , Humans , Male , Middle Aged , Osteotomy/standards , Pain/diagnostic imaging , Pain/physiopathology , Postoperative Complications/diagnostic imaging , Postoperative Complications/physiopathology , RadiographySubject(s)
Hip Dislocation, Congenital/surgery , Osteotomy/methods , Pelvic Bones/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
Both authors have dedicated most of their time since 1948 to the treatment of fractures in children. On the basis of their experience they are therefore submitting to the medical public those methods and results of the conservative treatment of fractures and dislocations in children which stood the test of time. The experiences of both authors as well as successful therapeutic methods of other surgeons are discussed in this book. Differences are stated between fractures in adults and in children which may be attributed to the growth factor of children's bones and their enormous biological drive. These factors will play their part in correcting certain displaced fractures by re-moulding, fractures which in an adult would have to be perfectly reduced unless a permanent deformity should ensue associated with subsequent impairment of function to the injured limb. The authors are stating which displaced angulations and side to side displacements in a fracture may be left and which must be repaired under all circumstances and why, if conservative treatment fails, surgery has to be performed. Sideways and longitudinally displaced fractures, especially metaphysial ones do not warrant a perfect reduction. Rotational displacements must be corrected every time even in very small infants e.g. in newborn babies. Age plays an important part in the healing of fractures. Moulding and union of a fracture will be most rapid in newborn babies and infants while in fractures of adolescents a similar procedure has to be adopted as in fractures of adults. Special problems of epiphysiolyses and epiphysial fractures are discussed emphasizing that conservative treatment may be unsuccessful in epiphysiolyses Salter-Harris type III and IV and surgical intervention may be indicated. Fractures of upper and lower limbs are dealt with in detail while paying special attention to obstetrical fractures. Fractures round the elbow are treated in a similar manner, they will frequently heal in angulation of the upper limb and may cause nerve injuries and ischaemic changes of the forearm. Special attention is being paid to the longitudinal overgrowth of fractures of the femoral diaphysis associated with the sequelae of the treatment of these very serious injuries to newborn babies and infants as well as to toddlers and older children.
