We aimed to investigate the early radiological effects of Dega and Pemberton iliac osteotomies that were performed in patients aged 4-8 years with developmental dysplasia of the hip on development of hip joint. Dega osteotomy or Pemberton osteotomy was performed in 76 hips of 58 patients because of developmental dysplasia of the hip between September 2011 and June 2015 and were evaluated retrospectively. Of a total of 76 hips, Pemberton osteotomy was performed on 39 (19 unilateral) and Dega osteotomy was performed on 37 (21 unilateral). In all hips, the acetabular index, acetabular depth ratio, centre-edge angle of Wiberg, and Reimer's index values were recorded preoperatively and at the final follow-up. We measured the surface areas of the femoral head ossific nucleus in patients with unilateral dysplastic hips and compared results before both osteotomy procedures and at the final follow-up. There were no statistically significant differences between the groups in terms of the acetabular index and acetabular depth ratio values (P>0.05) preoperatively and at the final follow-up, but the mean centre-edge angle of Wiberg and Reimer's index values showed significant statistical differences in favor of the Dega procedure (P<0.05). There was a statistically significant difference in favor of the Pemberton procedure when the mean ratio of the surface area of the femoral head ossific nucleus on the dysplastic side in relation to the normal side was compared preoperatively (P=0.042) and at the final follow-up (P=0.027) in unilateral hips. Although Dega and Pemberton osteotomies produce satisfactory radiological outcomes at early stages in children aged 4-8 years with developmental dysplasia of the hip, a higher rate in the surface area of the femoral head ossific nucleus was observed in the Pemberton osteotomy group, which also had a lower mean age than the Dega osteotomy group.
Osteochondromas are the most common benign bone tumors which are mostly seen in the metaphysis of distal femur, proximal tibia, and proximal humerus. As arising from flat bones such as scapula is a rare case, intra-articular osteochondroma is also rare. When the literature is searched it appeared that the scapula and shoulder joint are an uncommon site for osteochondroma. We present a case in which a patient had an osteochondroma placed in shoulder joint and originated from scapula which is a rare situation determined in the literature.
ÖZAmaç: Bu çalışmada Pemberton osteotomisi sonrası erken dönemde görülen radyolojik değişikliklerin kalça eklemi gelişimi ile olan ilişkisi değerlendirildi. Hastalar ve yöntemler:Ocak 2010 -Aralık 2014 tarihleri arasında yapılan bu çalışmaya gelişimsel kalça displazisi nedeniyle Pemberton osteotomisi uygulanan 75 hastanın (25 erkek, 50 kız; ort. yaş 31.5 ay; dağılım 15-71 ay) 101 kalçası (26 iki taraflı) dahil edildi. Radyolojik olarak merkez kenar açısı, asetabüler indeks (Aİ), asetabüler derinlik indeksi (ADİ) parametreleri değerlendirildi. Ön-arka pelvis grafilerinde femur başı kemikleşme merkezinin yüzey alanı ölçüldü. Kalça dislokasyon derecesi Tönnis sınıflandırmasına göre, femur başı avasküler nekrozu KalamchiMacEwen sınıflandırmasına göre derecelendirildi. Ameliyat edilen kalçalar tüm hastalarda ve sadece tek taraflı ameliyat edilen hastalarda takip sürelerine göre 12 ay, 12-24 ay ve 24 aydan fazla olmak üzere üç gruba ayrıldı. Tüm takip sürelerinde radyolojik parametrelerin ilişkileri incelendi. Bulgular: Ortalama takip süresi 22.5 ay (dağılım, 6-66 ay) idi. Ameliyat öncesi ortalama Aİ 42.25° (dağılım, 29°-60°), son takip ortalama Aİ 20.45° (dağılım, 10°-32°) idi. Ameliyat öncesi ortalama ADİ 16.48° (dağılım, 9°-30°), son takip ortalama ADİ 26.1° (dağılım, 23°-47°) idi. Altmış kalça Tönnis tip 4, 26 kalça tip 3 ve 15 kalça tip 2 idi. Takip süresi sınıflandırmasına göre; 12 ay takip süresi olan 32 kalça (21 tek taraf), 12-24 ay takip süresi olan 43 kalça (17 tek taraf) ve 24 aydan fazla takip süresi olan 26 kalça (11 tek taraf) vardı. On sekiz femura kısaltıcı osteotomi uygulandı. Kalamchi-MacEwen sınıflandırmasına göre; 16 kalçada tip 1, iki kalçada tip 2, üç kalçada tip 3, iki kalçada ise tip 4 avasküler nekroz vardı. Tekrar eden subluksasyonlar nedeniyle beş kalçada revizyon ameliyatı uygulandı.Sonuç: Pemberton osteotomisi sonrası erken dönemde, kalça eklemlerinde ve bunun sonucu olarak da radyolojik parametrelerde progresif düzelme görüldü.Anahtar sözcükler: Kalça displazisi; kalça çıkığı; Pemberton osteotomisi; radyolojik takip. ABSTRACTObjectives: This study aims to evaluate the relationship of early-term radiological changes with development of the hip joint after Pemberton osteotomy. Patients and methods:This study, which was conducted between January 2010 and December 2014, included 101 hips (26 bilateral) of 75 patients (25 males, 50 females; mean age 31.5 months; range 15 to 71 months) which were performed Pemberton osteotomy due to developmental dysplasia of the hip. Radiologically, we assessed the parameters of centeredge angle, acetabular index (AI), and acetabular depth index (ADI). We measured the surface area of the femoral head ossific nucleus on anteriorposterior pelvic X-rays. We graded the degree of hip dislocation according to Tönnis classification while the femoral head avascular necrosis was graded according to Kalamchi-MacEwen classification. We separated the operated hips in all patients and in only unilaterally operated patients in three groups according to their follow-up dura...
Objective: To examine hip development in a patient who underwent Dega osteotomy due to developmental dysplasia of the hip (DDH) by means of radiography. Materials and Methods: Dega osteotomy was performed on 43 hips (7 were bilateral) of 36 patients with DDH. In preoperative and final follow-up; the acetabular index (AI), acetabular depth ratio (ADR) and Wiberg's center-edge angle (CEA) were measured in anteroposterior pelvic radiographs. Hips were classified in accordance with Tönnis classification system. Radiological findings were evaluated in accordance with Severin classification system. Avascular necrosis (AVN) of the hips were evaluated according to Kalamchi-MacEwen classification system. Results: The mean age was 87 months (48-130 months), mean follow-up period was 30.5 months (15-62 months). The mean preoperative and final follow-up values of AI were 43° (28°to 60°) and 19° (6° to 34°), respectively. The mean preoperative and final follow-up values of ADR were detected as 14 (8 to 24) and 26 (18 to 42), respectively.The mean CEA was found as 38° (18° to 61°) at the final follow-up. Of the hips, 37 were Tönnis type 4 and 6 were Type 3. Totally 10 hips had AVN; of those, 6 were Type 1, 2 were Type 2 and 2 were Type 3 hips. According to Severin classification, 11 hips were Type 1a, 3 were Type 1b, 22 were Type 2a, 5 were Type 2b and 2 were Type 3. Conclusion: In patients who underwent Dega osteotomy, hip development can be detected radiographically with satisfactory levels.
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