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A 6-year-old female with cerebral palsy and a pelvic migration index of 40%
12%
403/3363
A 4-year-old male with an acetabular index of 35 degrees previously treated with a Pavlik harness
8%
278/3363
A 3-year-old male with asymptomatic congenital coxa vara and a Hilgenreiner-epiphyseal angle of 35 degrees
17%
561/3363
A 12-year-old female with pain on deep squat and a history of a slipped capital femoral epiphysis with 15 degree slip angle
21%
715/3363
A 9-year-old male diagnosed with Legg-Calve-Perthes who has painful hinge abduction on exam
40%
1337/3363
Select Answer to see Preferred Response
Patients with Legg-Calve-Perthes can have lateral column deformity resulting in impingement on the lateral lip of the acetabulum which can cause hinge abduction. These patients can benefit from a valgus-producing osteotomy to prevent this impingement. Legg-Calve-Perthes is a disease of idiopathic avascular necrosis of the femoral head. It is a self-limited process that typically affects 4 to 8-year-old children with a better prognosis in younger children. There are four phases to the disease process: Initial, fragmentation, reossification and healing/remodeling. As a result, the femoral head can become flattened and have a collapse of the lateral pillar. This femoral deformation can result in lateral femoral head impingement on the lateral acetabulum, also called hinge abduction. Yoo et al retrospectively reviewed 21 patients with hinge abduction after Perthes' Disease who underwent valgus femoral osteotomy with sagittal and rotational corrections. Their patients had significant improvement in Iowa Hip Scores (66 to 92 on average) at 7.1 years postop. Additionally, they had increased hip abduction movement of 28 to 51 degrees and increased internal rotation of 14 to 26 degrees. Both were significant changes. The acetabulum also remodeled after surgery with improvements in acetabular coverage, superior joint space, and decreased medial joint space. 18 of 21 patients had complete resolution of hip pain postop as well. Incorrect answers: Answer 1: This patient with CP and subluxation of the femoral head may benefit from a varus derotational osteotomy with or without femoral shortening and acetabuloplasty to improve the containment of the femoral head in the acetabulum. Answer 2: This patient has developmental hip dysplasia that failed conservative measures as acetabular index should be <25 degrees at 6 months of age. He would likely benefit from a pelvic osteotomy with or without femoral osteotomy. Answer 3: Asymptomatic congenital coxa vara with near-normal Hilgenreiner-epiphyseal angle can be treated with observation. Answer 4: Patient's with a history of an SCFE now showing evidence of femoroacetabular impingement would likely benefit from a femoral osteochondroplasty to remove the CAM deformity that can develop longterm.
1.5
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