Background:There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age.Materials and Methods:Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used.Results:Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hipsConclusion:In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.
Introduction: Traumatic fracture-dislocations of the shoulder and hip are serious injuries caused by high-energy trauma and can lead to long-term morbidity. Case Report: In this case report, we present a case of rare orthopedic emergency due to right hip dislocation, acetabular fracture, pertrochanteric femoral fracture, left inferior shoulder dislocation, and left proximal humerus fracture in a 72-year-old male patient suffering from a traffic accident that occurred while the patient was sitting inside the car. Conclusion: The occurrence of both inferior shoulder dislocation with fracture (luxatio erecta) and fracture-dislocation of the hip are extremely rare and have not been described previously in a single patient. Rates of complications and additional injuries are high in both situations.Keywords: Dislocation, fracture, shoulder, hip Received: 12.02.2015 Accepted: 01.07.2015 ÖZET Giriş: Travmatik omuz ve kalça kırıklı çıkıkları yüksek enerjili travmalar sonucu oluşan ve uzun süreli morbiditeye yol açabilen ciddi yaralanmalardır. Olgu Sunumu: Bu olgu sunumunda, 72 yaşındaki erkek hastada, araç içi trafik kazası sonucu oluşan, sağ kalça çıkığı, asetabulum kırığı, pertrokanterik femur kırığı, sol inferior omuz çıkığı ve sol proksimal humerus kırığının birlikte olduğu nadir bir ortopedik acil olguyu sunduk. Sonuç: Oldukça nadir görülen kırık ile birlikte inferior omuz çıkığı (luxatio erecta) ve kalçanın kırıklı çıkığı daha önce aynı hastada tariflenmemiştir. Her iki durumunda da komplikasyon ve ek yaralanma oranları yüksektir.
Introduction: Osteogenesis Imperfecta (OI) is a connective tissue disorder, which is the most common cause of genetic osteoporosis characterized by long bone deformities and fractures. The key defect is the qualitative and quantitative lack of type I collagen. The primary target in these patients is to fix deformities and to prevent fractures. The surgical application is often a basic surgical technique known as "Shish Kebab" osteotomy and mainly based on the principle of multiple osteotomies, fixation, and intramedullary nailing. In the present study, we present our results of the modified Sofield procedure for osteogenesis imperfecta-related lower extremity deformities.
Özet Amaç: Tibianın alt 1/3 lük kısmında gelişen kırıklarda kaynamama sık karşılaşılan bir problemdir. Bu durumua ince yumuşak doku örtüsü ve zayıf kanlanma gibi durumlar sebep olurlar. Ayrıca ayak bileğine yakınlık ve kısa distal segment gibi mekanik problemler kaynamama probleminin tedavisini oldukça güçleştirir. İntramedüller çivileme, bu soruna güçlü bir çözüm sunar. Çünkü geniş diseksiyona gerek kalmaz ve implant intraosseöz kalarak yumuşak dokular için minimum problem oluşturur. Bu çalışmanın amacı, tibianın alt 1/3 lük kısmındaki kırıklarda gelişmiş olan kaynama kusurlarının tedavisinde oyulmuş intramedüller çivinin etkinliğini belirlemektir. Gereç ve Yöntemler: Tibia alt 1/3’lük bölge kırığı sonrasında kaynamama gelişen ve sonrasında oymalı intramedüller çivi ile tedavi edilen 14 hastanın verileri retrospektif olarak incelendi. Çalışmaya tibia 1/3 distalindeki kırığı kaynamayan ve aktif enfeksiyon bulgusu olmayan tüm hastalar dahil edildi. İki hastada ilk operasyon sonrası ortaya çıkan yüzeysel enfeksiyon öyküsü vardı, ancak ameliyat sırasında hiçbir hastada aktif enfeksiyon belirtisi yoktu. Tüm hastalar oymalı kilitli intramedüller çivileme ile tedavi edildi. Bulgular: Hastaların hepsinde kaynama elde edildi. Ortalama kaynama süresi 5.7 (3-10) ay idi. Hiçbir hastada enfeksiyon gelişmedi. Sonuç: Oymalı kilitli intramedüller çivileme, tibianın alt 1/3’lük bölgesinde görülen ve tedavisi oldukça güç olan kaynamamaların tedavisinde gayet güvenilir bir yöntemdir.
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