Morbus Perthes – Neuigkeiten in der Diagnostik und Behandlung

Westhoff, Bettina; Lederer, Caroline; Krauspe, Rüdiger

doi:10.1007/s00132-019-03737-2

Cited by 12 publications

(3 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…K-wire fixation as an alternative to screw fixation has previously been reported in pelvic surgery. It is successfully used for fixation of pelvic osteotomies in children and adolescents and also, for example, in pelvic osteotomies for Perthes disease [ 24 ]. However, the conditions in these cases can only be applied to the biomechanical conditions in PAO in adults to a limited extent.…”

Section: Discussionmentioning

confidence: 99%

Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

Leopold

Conrad

Zahn

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Aims The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. Patients and methods We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16–48) in the K-wire group and 27.3 (15–45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up. Results Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53–202) compared to the screw group with 119.7 min (50–261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters. Conclusion K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal. Level of evidence III, retrospective trial.

show abstract

Section: Discussionmentioning

confidence: 99%

Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

Leopold

Conrad

Zahn

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…However, traditional PFVO has been associated with signi cant biomechanical impairments, and it has been criticized that containment treatment by PFVO disregards potential longterm sequelae [10]. Apart from producing leg length discrepancies through femoral shortening, the greater trochanter is inevitably proximalized, resulting in an overriding greater trochanter and, consecutively, insu ciency of the hip abductor muscles which frequently leads to Trendelenburg gait [11,12]. Moreover, an overriding greater trochanter may contribute to increased pressure to the femoral head, which may result in further chondral damage [13].…”

Section: Introductionmentioning

confidence: 99%

Modified trochanteric flip osteotomy in varus intertrochanteric osteotomy for treatment of Legg-Calvé-Perthes disease

Laufer,

Antfang,

Gosheger

et al. 2024

Preprint

View full text Add to dashboard Cite

Background Legg-Calvé-Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to address biomechanical consequences and improve hip abductor muscle strength. Methods We present a modified approach combining PFVO with a trochanteric flip osteotomy. In this technique the greater trochanter in compound with its muscular insertions is separated from the femur and attached distally using a varization blade plate. Eight patients (nine hips) with LCPD were treated using this technique. Clinical examination findings and radiographic evaluations were retrospectively analyzed. The median follow-up was 28 months. Results At the last follow-up, two patients exhibited Trendelenburg gait, but hip abduction was improved in all patients. Radiographically, consolidation at the osteotomy site was observed in all cases, with no delayed union or non-union. The mean CE angle improved by 7.6°, while the mean CCD decreased by 19.5°. The mean MPFA decreased by 17.5° resulting in a mean of 81°. Conclusion Combining PFVO with a modified trochanteric flip osteotomy addresses biomechanical issues associated with PFVO, potentially improving hip containment and abductor muscle strength. This approach may offer advantages over traditional osteotomy techniques in treating LCPD. Despite satisfactory radiological outcomes in most cases, further research is needed to assess long-term effectiveness and address challenges such as femoral head enlargement and persistent gait abnormalities.

show abstract

“…Nonoperative management is generally recommended in this age group, although some advocate for operative management [36,43]. There is no treatment consensus among experts worldwide [42]. Nonoperative management includes weightbearing and activity modifications, which help decrease the magnitude of hip contact forces that might contribute to deformity of the weakened femoral head [2].…”

Section: Introductionmentioning

confidence: 99%

Moderate Weightbearing Restrictions Are Associated with Worse Depressive Symptoms and Anxiety in Children Aged 5 to 7 Years with Perthes Disease

Valencia

et al. 2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Perthes disease most commonly affects children 5 to 7 years old, and nonoperative management, such as weightbearing and activity restrictions, is generally recommended. In earlier research in children aged 8 to 14 years who had Perthes disease, we found that the restrictions were associated with worse mobility, but mental health or social health measures were not linked. However, Perthes disease most commonly affects children 5 to 7 years old who are more emotionally and cognitively immature. Children in this age group are beginning school and organized sports experiences while developing meaningful social relationships for the first time. Because of such different life experiences, it is important to One author (HKWK) holds a patent for an osteonecrosis treatment device. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

show abstract

Morbus Perthes – Neuigkeiten in der Diagnostik und Behandlung

Cited by 12 publications

References 50 publications

Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

Modified trochanteric flip osteotomy in varus intertrochanteric osteotomy for treatment of Legg-Calvé-Perthes disease

Moderate Weightbearing Restrictions Are Associated with Worse Depressive Symptoms and Anxiety in Children Aged 5 to 7 Years with Perthes Disease

Contact Info

Product

Resources

About