Extreme femoral shortening: an approach to the chronically dislocated hip in the nonambulatory pediatric population.

There are many surgical techniques for treating the chronically dislocated, painful hip in patients with neuromuscular spasticity, but each has significant complication rates. We conducted a study to examine the outcomes of a novel technique, an extreme varus femoral shortening osteotomy, used in nonambulatory patients with neuromuscular spasticity. Patients who underwent the procedure were identified retrospectively by surgical codes. Medical records were reviewed for range of motion, pain and functional assessment, surgical indications, complications, and results. In addition, preoperative and postoperative radiographs were assessed, and caretaker questionnaires reviewed. Between 2001 and 2010, 1 surgeon performed 6 femoral shortening osteotomies in 5 nonambulatory patients with neuromuscular spasticity. In all 5 cases, there were improvements in pain, sitting tolerance, ease of hygiene, and ease of transfers at a minimum follow-up of 2 years (mean, 3.4 years). Postoperative complications included asymptomatic heterotopic ossification and recurrent subluxation. Extreme femoral shortening is a reproducible surgical technique that alleviates pain and makes hygiene easier in nonambulatory children with symptomatic hip dislocations caused by neuromuscular spasticity. Our complication rate was comparable to that of other procedures.

Intertrochanteric hip fractures treated with the trochanteric fixation nail and sliding hip screw.

The primary treatment options for intertrochanteric hip fractures are a sliding hip screw (SHS) and an intramedullary device, with each having its own advantages and disadvantages. The authors retrospectively compared all intertrochanteric hip fractures between 2003 and 2005 using a cephalomedullary nail--the trochanteric fixation nail (TFN)--to those using a SHS. Outcome measures included the following parameters: age, gender, fracture classification, operation time, blood loss, transfusions, complications, follow-up, length of stay, and hospital cost. A total of 95 patients were included in the study (51 SHS and 44 TFN). The two groups were similar in age (p = .52), blood loss (p = .20), follow-up (p = .13), length of stay (p = .63), and hospital costs (p = .70). The TFN procedure required shorter operative times (56.5 min, p < .004) and was used in more complex fracture patterns (p < .03). The SHS group had fewer blood transfusions (1.2 units, p < .0008). The SHS group had a higher complication rate of 19.6%, versus the TFN group's 11.4% rate (p = .13). The TFN is an appropriate and acceptable treatment method for intertrochanteric hip fractures.