Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.

Hdl Handle:
http://hdl.handle.net/10147/314993
Title:
Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.
Authors:
Conroy, Eimear; Sheehan, Eoin; O' Connor, Phillip; Connolly, Paul; McCormack, Damian
Citation:
Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review. 2010, 19 (4):323-6 J Pediatr Orthop B
Journal:
Journal of pediatric orthopedics. Part B
Issue Date:
Jul-2010
URI:
http://hdl.handle.net/10147/314993
DOI:
10.1097/BPB.0b013e32833822a4
PubMed ID:
20386118
Abstract:
Femoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter's osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter's osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged from 9 to 24 whereas postoperative scores ranged from 25 to 46. Triple osteotomy has been advocated in Legg-Calve-Perthes' disease after the closure of the triradiate cartilage. Using a single incision is a safer alternative to the traditional two-incision approach. We believe that the single incision approach reduces operative time and potential morbidity associated with the steel triple osteotomy with comparable clinical and radiographic outcomes.
Item Type:
Article
Language:
en
MeSH:
Child; Humans; Legg-Calve-Perthes Disease; Length of Stay; Male; Osteotomy; Pain; Pelvic Bones; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Surgical Procedures, Minimally Invasive; Treatment Outcome
ISSN:
1473-5865

Full metadata record

DC FieldValue Language
dc.contributor.authorConroy, Eimearen_GB
dc.contributor.authorSheehan, Eoinen_GB
dc.contributor.authorO' Connor, Phillipen_GB
dc.contributor.authorConnolly, Paulen_GB
dc.contributor.authorMcCormack, Damianen_GB
dc.date.accessioned2014-03-31T08:43:38Z-
dc.date.available2014-03-31T08:43:38Z-
dc.date.issued2010-07-
dc.identifier.citationTriple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review. 2010, 19 (4):323-6 J Pediatr Orthop Ben_GB
dc.identifier.issn1473-5865-
dc.identifier.pmid20386118-
dc.identifier.doi10.1097/BPB.0b013e32833822a4-
dc.identifier.urihttp://hdl.handle.net/10147/314993-
dc.description.abstractFemoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter's osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter's osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged from 9 to 24 whereas postoperative scores ranged from 25 to 46. Triple osteotomy has been advocated in Legg-Calve-Perthes' disease after the closure of the triradiate cartilage. Using a single incision is a safer alternative to the traditional two-incision approach. We believe that the single incision approach reduces operative time and potential morbidity associated with the steel triple osteotomy with comparable clinical and radiographic outcomes.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Journal of pediatric orthopedics. Part Ben_GB
dc.subject.meshChild-
dc.subject.meshHumans-
dc.subject.meshLegg-Calve-Perthes Disease-
dc.subject.meshLength of Stay-
dc.subject.meshMale-
dc.subject.meshOsteotomy-
dc.subject.meshPain-
dc.subject.meshPelvic Bones-
dc.subject.meshRange of Motion, Articular-
dc.subject.meshRecovery of Function-
dc.subject.meshRetrospective Studies-
dc.subject.meshSurgical Procedures, Minimally Invasive-
dc.subject.meshTreatment Outcome-
dc.titleTriple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.en_GB
dc.typeArticleen
dc.identifier.journalJournal of pediatric orthopedics. Part Ben_GB
dc.description.fundingOtheren
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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