Two article for LCP

[Accuracy of proximal femur correction achieved with LCP paediatric hip plates].

Abstract

PURPOSE OF THE STUDY:

The aim of the study was to evaluate, in comparison with the pre-operative planning, the accuracy of proximal femur correction achieved with the use of locking compression paediatric hip plates (LCP) in children and adolescents and to assess pre- and post-operative complications.

MATERIAL AND METHODS:

A group of 52 patients in whom proximal femoral osteotomy using the LCP was performed on a total of 55 hips between September 2009 and February 2013 were retrospectively evaluated. The following diagnoses were treated: unstable hip in cerebral palsy, 18 operations; Legg-Calvé-Perthes disease, 10 operations; coxa vara of aetiology other than coxa vara adolescentium (CVA), eight operations; true CVA, six operations; femoral shortening by the Wagner method, six procedures; proximal femoral derotation osteotomy, four procedures; and post-traumatic pseudoarthrosis of the proximal femur, three operations.

RESULTS:

Compared with the pre-operative plan, the average deviation of the colodiaphyseal angle was 5.2° (1° to 11°) in 18 unstable hips; 4.7° (1° to 10°) in 10 cases of Legg-Calvé-Perthes disease; 4.5° (3° to 6°) in eight hips with coxa vara of aetiology other than CVA; 6.5° (2° to 13°) in six CVA hips; 4.5° (1° to 10°) in six cases of femoral shortening; 3.5° (1° to 5°) in four derotation osteotomies; and 3.7° (0° to 6°) in three corrections of pseudoarthrosis. In one patient, osteosynthesis failed due to screws being pulled out from the proximal fragment; re-osteosynthesis was carried out using a conventional angled blade plate.

DISCUSSION:

As in other international studies, our results confirmed a high accuracy of proximal femur correction with use of the LCP instrumentation. The reported higher time requirement for this technique seems to be related to the learning curve and, with more frequent use, will probably be comparable to the time needed for application of conventional hip angled plates.

CONCLUSIONS:

The up-to-date LCP fixation system using the principle of angular stability for correction of the proximal femur in children is a clear advancement and its higher costs are certain to be outweighed by its higher accuracy and thus better results.

PMID:

 

24119475

 

[PubMed - in process]

 

[Tönnis and Kalchschmidt triple pelvic osteotomy].

Abstract

OBJECTIVE:

With three precise osteotomies it is possible to move the acetabulum to achieve sufficient coverage in dysplastic hips.

INDICATIONS:

Main indication is a painful dysplastic hip. Other acetabular pathologies, such as retroversion can also be addressed. In recent years young patients with Legg-Calve-Perthes disease

CONTRAINDICATIONS:

Patients with an arthrosis (Tönnis level 2) and obesity often have poor results. Therefore the combination of these parameters should be seen as a contraindication.

SURGICAL TECHNIQUE:

The operation starts with the patient in a lateral decubitus position. The first incision is parallel to the sacrotuberal ligament. The gluteus maximus muscle is spread until the ligament itself with its bony connection at the tuber ischiadicum is visible. After putting two special retractors in the foramen obturatorium and one to the spina ischiadica, osteotomy of the os ischium is performed from the incisura ischiadica to the foramen obturatorium. For the next osteotomy the os pubis is approached and it should be performed subperiostally. The vasa and nervus obturatorius and femoralis should be protected. At the os ilium the abdominal muscles are separated from the iliac crest. The third osteotomy has a 90° angle and starts at the linea terminalis and leads just below the spina iliaca anterior superior iliac spine. The acetabulum can now be moved with a Schanz screw. At this point it is necessary to elevate the os pubis while moving the acetabulum laterally. This prevents a lateralization and reduces the distance at the iliac osteotomy. The osteosynthesis is performed with screws at the os ilium and also at the os pubis.

POSTOPERATIVE MANAGEMENT:

Patients are advised to avoid weight bearing for 12 weeks. In the first 6 weeks they are allowed to perform a maximum flexion of 60°.

RESULTS:

According to the Harris hip score 80.4 % of the patients showed good and very good results after 11.5 years. In cases with arthrosis and obesity a higher rate of poor results were found.

PMID:

 

24085351

 

[PubMed - in process]