Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day...
Transcript of Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day...
Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics
Rutgers-New Jersey Medical School
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
Program.
I have no conflicts.
•Severe SCFE = worse prognosis
•Altered biomechanics
•Femoro-Acetabular impingement
•Various realignment strategies
•Percutaneous Osteotomy / Ilizarov
Modified Southwick osteotomy Half-pins in proximal / distal fragments Femoral arches orthogonal to each fragment Percutaneous multiple-drill hole osteotomy Triplanar correction Reposition arches parallel to each other Connect arches with threaded rods Fine tune with conical washers
1.8 mm wire Femoral Arches 4.8 mm drill bit HA coated pins Osteotomes Threaded rods Conical washers
Radiolucent table Supine Bump under buttock
Orthogonal Femoral Arches
Frontal view
Percutaneous multiple drill hole osteotomy with correction
1. Internal Rotation 2. Anterolateral Translation 3. Flexion and Abduction
Threaded rods / Conical washers Both arches almost parallel
• Follow up: 23 (6 – 49) months
• Time in OR: 143 (118 – 210) mins
• Blood loss: 61 (50 – 100) cc
• Hospital stay: 2.4 (2 -4) days
• Time in fixator: 18 (14 – 23) weeks
Results: Range of Motion
ROM (deg) Pre-op Post-op Diff p value
Flexion 74 106 33 0.02 (20 – 90) (95 – 130)
IR -5 17 24 0.007
(-33 – 15) (5 – 40)
ER 71 41 29 0.0003
(25 – 90) (5 – 68)
Abduction 29 36 12 0.23
(14 – 50) (25 – 45)
Results: Radiographic
Pre-op Post-op Diff p value
AP Head Shaft 112 134 22 0.004 Angle (deg) (84 – 138) (117 – 154)
Lat Head Shaft 72 15 57 <0.0001
Angle (deg) (57 – 101) (-2 – 26)
LLD (cm) 1.8 1.8 1.2 0.80
(0.6 – 2.9) (0 - 4)
Postop Scanogram
Before osteotomy
After removing external fixator
Transient chondrolysis 1 Fixation related problems 0 Deep infection 0 AVN 0 Refracture 0 Unplanned OR 0
Langenskiold
Pauwels
Borden
0
20
40
60
80
100
120
140
Preop Post op Final F/u
74°Pre op 33°Post op (∆=41°)
0
20
40
60
80
100
120
140
160
Preop Post op Final F/u
86°Pre op 137°Post op (∆=51°)
-20
-15
-10
-5
0
5
10
15
20
25
30
Preop Post op Final F/u
- 6 mm Pre op + 11mm Post op (∆=17 mm)
Safe Effective in large patients Accurate / sustained correction Minimize blood loss Avoids further shortening May do lengthening as needed Early mobilization
Need to be familiar with ex fix Time in fixator Pin related issues Impact on future surgery ? Short follow up
Percutaneous technique appears safe and effective in correcting pediatric proximal femoral deformities associated with: SCFE
Developmental Coxa Vara
Painful Dislocated Hips in CP
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
Program.
I have no conflicts
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
program.
My disclosure is: