ABSTRACT
OBJECTIVE: To evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH). METHODS: The study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification. RESULTS: Radiologically, forty eight (77%) hips were evaluated as "excellent", 8 (13%) hips as "good" and 5 (8%) hips as "fair plus" and 1 (%2) hip as "fair minus". Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had "excellent" and 6 (10%) had "good" results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy. CONCLUSION: Medial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Subject(s)
Femur/surgery , Hip Dislocation, Congenital , Osteonecrosis , Osteotomy , Postoperative Complications , Adolescent , Aftercare/methods , Female , Femur/pathology , Hip Dislocation, Congenital/diagnosis , Hip Dislocation, Congenital/epidemiology , Hip Dislocation, Congenital/surgery , Humans , Infant , Male , Osteonecrosis/diagnosis , Osteonecrosis/epidemiology , Osteonecrosis/etiology , Osteonecrosis/surgery , Osteotomy/adverse effects , Osteotomy/methods , Osteotomy/statistics & numerical data , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Radiography/methods , Reoperation/statistics & numerical data , Retrospective Studies , Turkey/epidemiologyABSTRACT
PURPOSE: We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. METHODS: A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. RESULTS: Deviation values ranged from -11Ì to +15Ì for the 27 cases in group A, with a median absolute deviation of 8̱6Ì. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5Ì to +6Ì, with a median absolute deviation of 0.5̱3Ì (P<0.001). The total numbers of attempts to place lag screws and mean operation time decreased significantly after introduction of the new guide system (P<0.001). CONCLUSIONS: With this new guide system, we are able to insert lag screws successfully in the optimal position even in most unstable fractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts.
