Pelvic osteotomies are used for hip preservation in children and young adults to improve femoral head coverage and stabilize the hip joint. Redirectional osteotomies aim to reduce the overall volume and redirect the acetabulum. These include Salter, Pemberton, Dega, and San Diego osteotomies. Reorientation osteotomies aim to reorient the acetabulum and include periacetabular and triple osteotomies. Salvage osteotomies aim to enlarge the acetabulum and medialize the hip center. These include shelf and Chiari osteotomies. The standard anterior approach and surgical technique for the eight pelvic osteotomies used by hip preservation surgeons are described along with each osteotomy's history, indications, and outcomes.
Objective: Compare outcomes of operative and non-operatively managed medial epicondyle fractures in upper-extremity athletes.Design: Retrospective chart review and phone survey.Setting: Level 1, tertiary-referral pediatric hospital.Patients: Propensity scores (probability of operative treatment) were estimated from a logistic regression model that included gender, age, displacement, limb dominance, and injury severity (presence of an additional fracture, nerve injury, or elbow dislocation). These were used to match subjects in the operative group to the non-operative group.Main Outcome Measures: Return to sport, duration of time required to return to sport, pain, range of motion, need for physical therapy, and complications were recorded for both groups.Results: 28 non-operative subjects were matched to 14 operative subjects. There was no significant difference in the proportion of subjects that returned to the same sport (92.9% in each group), performance at pre-injury level of competition, or median time to return to play (p = 0.7106). There was no significant difference in functional limitations in social/ work related activities (p > 0.9999), pain in the last 30 days (p = 0.0640), need for physical therapy (p = 0.5680), range of motion limitations (p = 0.0988), difficulty sleeping (p = 0.4773), or complications (p = 0.4081).
Conclusions:Our study found no statistical difference in outcomes or complications between operative and non-operatively treated moderately displaced medial epicondyle fractures in adolescent upper-extremity athletes. Our data shows similar outcomes may be achieved with both treatment groups for medial epicondyle fractures in upper-extremity athletes.
This study found that specific combinations of plication magnitude and location can be used to restore glenohumeral translation from a lax capsular state to a native state. This information can be used to guide surgical technique based on an individual patient's degree and direction of capsular laxity. In vivo testing of glenohumeral translation before and after capsular plication will be needed to validate these cadaveric results.
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