Congenital Dislocation of the Hip in Children between the Ages of One and Three: Open Reduction and Modified Salter Innominate Osteotomy Combined with Fibular AllograftReportar como inadecuado




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Background: Innominate osteotomy procedures have been widely usedas an integral component of combined surgery to treat developmental dysplasiaof the hip in children. Autograft concern is further supported by authors whosuggest the routine use of internal fixation. Problems such as graft extrusion,rotation and absorption, leading to loss of acetabular correction, were oftennoted in cases previously treated at our National Hospital for Pediatrics. Thisretrospective study reviewed the radiographic results of this treatmentprotocol in 106 hips developmental dislocated hips which met our inclusioncriteria. The efficacy of this method to achieve and maintain a well coveredand stable hip was the main objective of the study. Methods: Thisretrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which weretreated by modified Salter’s innomiate osteotomy and using a fibular allograftas the interposition material. Dislocations of the hip were graded using theT?nnis system. Measurement of the acetabular index AI was the main variable.The minimum follow up period was 2 years.Possible complications such as loss of acetabular correction, hip redislocation,graft extrusion or resorption, the need for osteotomy internal fixation,delayed or non union, infection or avascular necrosis AVNwere documented in this series. Results: Between January 2004 and December2008, 106 surgeries were performed in 95 patients. Sixty-three 86.3% of the patients were girls andten 13.7% were boys, thirteenpatients 13.7% were between twelve and eighteen months old at the time of theoperation, the remaining eighty-two 86.3%patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven 11.6% patients who had bilateral dislocation. Eighty-four88.4% patients were affected unilaterally. The right hip was involved inseventeen 17.9% and the left hip in sixty-seven 70.5% cases. T?nnis system Type 3 was in 34 hip 32.1%,and Type 4 was in 72 hip67.9%. All patients combined open reduction and modified Salter’s innomiateosteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. Allof the fibulat allografts were completely incorporated mean 14 weeks range, 12weeks - 17 weeks post-surgery. There were five 4.7% redislocation andsubluxation, three AVN 2.8% and five 4.7% coxa magna Without graft infections,none of the osteotomies required internal fixation for stability. Final results: Excellent 70 66.0%,Good 29 27.4%, Fair 2 1.9%,Poor 5 4.7%. Conclusion: Open reduction and modified Salter’s innomiate osteotomy allowinterposition material by fibular allografting with a short operative incision,renders excellent osteotomystability that eliminates the need for internal fixation. Surgical techniqueare safe and effective for Childrenbetween twelve and thirty-sixmonths old.

KEYWORDS

Hip Dysplasia; Innominate Osteotomy; Congenital Dislocation of the Hip; Development Dysplasia of the Hip; Allograft

Cite this paper

N. Hung -Congenital Dislocation of the Hip in Children between the Ages of One and Three: Open Reduction and Modified Salter Innominate Osteotomy Combined with Fibular Allograft,- Open Journal of Orthopedics, Vol. 3 No. 2, 2013, pp. 137-152. doi: 10.4236-ojo.2013.32026.





Autor: Nguyen Ngoc Hung

Fuente: http://www.scirp.org/



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