Background: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666–679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499–507].
Objective: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function.
Patients and methods: This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10–18 years). The mean follow-up period was 14.5 months (6–36 months).
Results: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip score (HHS) was (96.16 ± 9.7) and the mean improvement was (29.6 ± 9.6) (p = 0.0000).
Conclusions: The modified Dunn procedure allows to restore the normal proximal femoral anatomy by complete correction of the slip angle. This technique may reduce the probability of secondary osteoarthritis and femoroacetabular cam impingement.
Background: Lumbar spinal fusion is a common surgical procedure for treatment of lower back pain caused by degeneration of lumbar disc. The aim of fusion is to prevent motion in the destabilized segments to decrease the low back pain. A modified interspinous device can provide stabilization similar to pedicular screw fixation avoiding its complication when used for interbody fusion as a minimally invasive procedur. Aim of work is to investigate using a new fusion technique, consist of trans-foraminal inter-body placement of peek cage and interspinous stabilization by rigid interspinous device which could provide stabilization of the posterior spinal elements similar to pedicle screw fixation as a minimally invasive procedure. Patient and Methods: The study involved 20 patients with signs of moderate segmental instability in lumbar spine .Transforaminalinterbody fusion using the polyethere-therketone(PEEK)cage and rigid interspinous device fixation was performed. Patients were followed up and treatment outcomes were assessed within approximately 24 months after surgery. Results: According to pain intensity level on the visual analogue scale, the need for painkillers and the quality of life according to the Oswestry Disability Index scale during the early postoperative period demonstrated significantly better outcomes due to a less severe operative trauma to the paravertebral soft tissues. The formation of interbody bone formation was observed after 20-36 months in 94% of patients. Postoperative complications occurred in 2.2% of patient. Conclusion: The use of transforaminalinterbody fusion and rigid interspinous stabilization provides better clinical outcomes and fewer postoperative complications in patients with moderate lumbar segmental instability.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.