A Modified Technique for Reconstruction of the Femoral Neck in Paediatric Patients

Libri, R; Reggiani, Leonardo Marchesini

doi:10.1177/112070001002000418

Cited by 3 publications

(10 citation statements)

References 9 publications

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“…The mean duration of follow-up in nine of these studies was 74 months (range 6 months to 192 month), and two articles did not mention the duration of follow-up. 11,15 In seven studies, triple osteotomies introduced by Morscher were applied 12,[15][16][17][18][19][20] and four studies reported results of double proximal femoral osteotomies. [9][10][11]21 Overall, 143 patients were included, of whom six underwent bilateral osteotomies (149 hips).…”

Section: Resultsmentioning

confidence: 99%

“…11,15 In seven studies, triple osteotomies introduced by Morscher were applied 12,[15][16][17][18][19][20] and four studies reported results of double proximal femoral osteotomies. [9][10][11]21 Overall, 143 patients were included, of whom six underwent bilateral osteotomies (149 hips). Demographic data are demonstrated in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Harris Hip Score was reported in 26 hips of 23 patients in two papers. 11,17 Mean scores increased from 73 to 95, 17 and from 83 to 94, after the osteotomy. 11 Six studies applied Merle d'Aubigné score in 76 hips (74 patients), and reported a mean a three-point increase in the overall score, from 14 (range seven to 16) to 17 (range two to 18).…”

Section: Functional Outcomesmentioning

confidence: 92%

“…4). 11,12,[16][17][18][19][20][21] In one study, acute correction of mean LLD from 32 mm (range 20 mm to 45mm) to 0.3 mm (range 0 mm to 10 mm) right after the surgery was reported, but at the end of follow-up, the mean effective limb lengthening was 19 mm (range 0 mm to 40 mm). The authors reported one case with loss of 30 mm of acquired length due to unauthorized early weight bearing.…”

Section: Limb Lengtheningmentioning

confidence: 99%

“…9 Precursory osteotomies were fixed by angle-blade plates, but some modifications in fixation method were introduced later. [10][11][12] Morscher triple osteotomy and the later double proximal femoral osteotomy seem to be unsophisticated and effective methods for lengthening the short femoral neck and improving the related disabilities in patients with coxa brevis. Although primary outcomes were promising and few complications were reported, no consensus exists about the indications for patient selection and appropriate target groups.…”

Section: Introductionmentioning

confidence: 99%

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A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis

Ghaffari

Kold

Rahbek

2020

Journal of Children's Orthopaedics

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Purpose Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening. Methods After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported. Conclusions Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips. Level of evidence III

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 92%

Section: Limb Lengtheningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis

Ghaffari

Kold

Rahbek

2020

Journal of Children's Orthopaedics

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Modifizierte Schenkelhalsverlängerungsosteotomie nach Morscher bei Kindern und Jugendlichen

Placzek

Gathen

Koob

et al. 2018

Oper Orthop Traumatol

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Morscher Osteotomy Through Surgical Dislocation Approach for True Femoral Neck Lengthening with Greater Trochanter Transposition

Faure

Zaltz

Côté

et al. 2020

Journal of Bone and Joint Surgery

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Background: Young adults presenting with hip pain can be affected by proximal femoral growth disturbances as seen in Legg-Calvé-Perthes disease (LCPD) or as a complication of surgical treatment of developmental dysplasia of the hip (DDH). In 1988, Morscher proposed a novel femoral neck lengthening osteotomy to address these issues. The purpose of this study was to evaluate the effectiveness and safety of the Morscher osteotomy as a procedure to complement the well-documented surgical hip dislocation, to increase femoral offset, to distalize the greater trochanter, and to increase the overall limb length. Methods: This study was a retrospective case series from 3 hip-preservation-expert surgeons. Morscher osteotomies performed through a surgical dislocation approach by 3 surgeons between January 2008 and September 2019 were reviewed. Fifteen patients with a median age at surgery of 17 years (range, 13 to 28 years) and a minimum follow-up of 3 months (until union) were included. Surgical indications, clinical findings, comparative radiographic analyses including the change in horizontal femoral offset and the position of the greater trochanter, and complications were assessed. Results: Surgical indications included DDH and LCPD. The horizontal femoral offset improved in all patients, to a median of 32.5 mm (range, 4 to 46.4 mm). The articular-trochanteric distance increased to >5 mm in all patients. Limb length improved by a median of 11.5 mm (range, 3 to 30 mm). Complementary periacetabular osteotomy was performed in 14 patients. The lateral center-edge angle and the acetabular index improved in patients with an associated periacetabular osteotomy, to a median of 28.2° (range, 9° to 37.7°) and 7.9° (range, 0° to 20°), respectively. Two patients demonstrated osteoarthritis progression from Tönnis stage 0 to stage 1, and 6 patients had a decrease of the joint space. Complications included 1 pulmonary embolism, 1 case of asymptomatic fibrous union of the greater trochanter, and 1 transient sciatic nerve palsy. Conclusions: The time-tested Morscher osteotomy indicated for complex proximal femoral reconstruction is effective in increasing horizontal femoral offset, distalization of the greater trochanter, and limb length. Combining the Morscher osteotomy with the versatility of surgical hip dislocation and the improved coverage capacity of periacetabular osteotomy proved complementary in the arsenal of hip preservation. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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A Modified Technique for Reconstruction of the Femoral Neck in Paediatric Patients

Cited by 3 publications

References 9 publications

A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis

A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis

Modifizierte Schenkelhalsverlängerungsosteotomie nach Morscher bei Kindern und Jugendlichen

Morscher Osteotomy Through Surgical Dislocation Approach for True Femoral Neck Lengthening with Greater Trochanter Transposition

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