DNB - ORTHOPAEDICS , PHY MED AND REHAB ( PMR )
MS - ORTHOPAEDICS
MD - PHY MED AND REHAB ( PMR )
FINAL EXAM…!!!
Q 5 EXPLAIN IN DETAIL -
A ) HINGED ABDUCTION
B ) STULBERG CLASSIFICATION IN PERTHES DISEASE
C ) MANAGEMENT PRINCIPLES FOR HINGED ABDUCTION AND COXA MAGNA
A 5 INTRODUCTION
1 Represents idiopathic avascular necrosis of femoral head in pediatric population aging 2–10 years old.
2 Indications for treatment depend mostly on prognosis about femoral head sphericity and hip congruence at the end of growth.
3 The affected femoral epiphysis undergoes varying degrees of self-limited necrosis, leading to a broad spectrum of pathology and evolution, from mild forms without sequelae to severe deformities with limited range of motion and early osteoarthritis of the hip
A ) HINGED ABDUCTION
1 Hinge abduction” is a complication of Perthes’ disease caused by impingement of the extruded superolateral portion of the femoral head against the lateral lip of the acetabulum.
2 Hinge abduction is an abnormal movement of the hip which occurs when a femoral head, deformed as a result of avascular necrosis or Perthes’ disease, fails to slide within the acetabulum.
3 Patients with this condition present with pain and shortening
B ) STULBERG CLASSIFICATION
1 - Sphericsl congruency
2 - Spherical congruency , loss of head shape to less than 2 mm - with one or more of the findings such as
A ) Coxa magna
B ) Short femoral neck
C ) obliquus acetabulum
( Good prognosis )
3 - Aspherical congruency , loss of head shape to more than 2 mm - non spherical head but not flat ( Poor prognosis )
4 - Aspherical congruency - flat head and acetabulum ( poor prognosis )
MANAGEMENT PRINCIPLES
A ) Hinged abduction
1 - Conservative
Traction for 10 weeks to 12 weeks followed by petrie cast
2 - Surgical procedures
A ) Varus femoral osteotomy
B ) Chiari osteotomy
C ) Shelf acetabuloplasty
D ) Triple pelvic osteotomy
E ) Chielectomy
B ) Coxa Magna
1 the beginning stages a varisation osteotomie gives a sufficient reduction of the joint pressure and a modelling of the enlarged head by the acetabulum is possible.
2 In later stages a detoriation of the head deformity with fixed adduction contracture can be caused by varisation osteotomie.
3 Enlarging the acetabulum laterally and ventrally and medializing the hip-joint by means of a Chiari pelvic-osteotomy reduces the joint pressure so far, that a restitution of the hip joint with round and congruent joint surfaces can be expected.
4 A lateralisation of the deformed femoral head with a secondary insufficiency of the acetabulum should also be treated by an additional pelvic osteotomy, if in the arthrography the lateral part of the head does not enter the acetabulum in abduction position.
5 In secondary osteochondritis in hip luxation the treatment should be equal.
6 Even an advanced secondary osteoarthritis after M. Perthes could be stopped by pelvic osteotomy over years.