Younger patients typically with open triradiate cartilage
Single cut above acetabulum through the ilium to sciatic notch. Acetabulum hinges through the pubic symphysis. The redirectional osteotomy can provide 20-25° lateral and 10-15° anterior coverage (coverage limitations in anterolateral head). May lengthen leg up to 1 cm.
Favored in older children because their symphysis pubis does not rotate well. Performed when open triradiate cartilages are present
Salter osteotomy plus additional cuts through superior and inferior pubic rami. Acetabular reorientation procedure.
Triradiate cartilage must be closed in order to perform
Involves multiple osteotomies in the pubis, ilium, and ischium near the acetabulum. This allows improved three-dimensional correction of the acetabulum configuration. It is technically the most challenging. Posterior column and pelvic ring remain intact and patients are allowed to weight bear early
Osteotomy starts approximately 10 to 15 mm above the AIIS, proceeds posteriorly, and ends at the level of the ilioischial limb of the triradiate cartilage (halfway between the sciatic notch and the posterior acetabular rim). Osteotomy hinges at the triradiate cartilage posteriorly and the symphysis pubis anteriorly. This osteotomy does do not enter the sciatic notch and is therefore stable and does not need internal fixation. Reduces acetabular volume
Osteotomy from acetabular roof to triradiate cartilage (incomplete cuts through pericapsular portion of the innominate bone). The acetabular configuration changes by hinging through the triradiate cartilage. This osteotomy does do not enter sciatic notch and is therefore stable and does not need internal fixation. Reduces the acetabular volume
The dial or spherical osteotomy leaves the medial wall or teardrop in its original position and, as a result, is intra-articular.
Add bone to the lateral weight-bearing aspect of acetabulum by placing an extra-articular buttress of bone over the subluxed femoral head. Depends on fibrocartilge metaplasia for successful results.
Make cut above acetabulum to sciatic notch and shift ileum lateral beyond edge of acetabulum. Depends on fibrocartilge metaplasia for successful results. Medializes the acetabulum via iliac osteotomy.
Please rate topic.
Average 4.5 of 88 Ratings
Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
Which of the following is true regarding the structure outlined in Figure A?
It is comprised of the iliopectineal eminence and quadrilateral surface
In normal hips, all children usually have this radiographic figure by 18 months of age
This figure is usually present in children with developmental dysplasia of the hip prior to reduction
The structure is a result of the radiographic superimposition of the ilioischial and Iliopectineal lines
It is comprised of the cotyloid fossa and iliopectineal eminence
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A 6-week-old female infant is referred to your practice for concerns of developmental dysplasia of the hip. On physical exam, you note a positive Ortolani test on the left side. Pavlik harness treatment is initiated. Which of the following imaging modalities should be utilized at the two week follow-up visit?
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Arthrogram and Dynamic Fluroscopy
Which of the following best describes the radiographic measurement labeled #1 on Figure A.
A 15-year-old soccer player complains of bilateral hip pain. The pain is worse with activity and she notices that she has fatigue and pain that extends to the thighs and knees following a soccer match. She is nontender at the pubis symphysis and has no pain with resisted abdominal crunches. She has no pain with adduction of the hip. Hip flexion and rotation is normal. A radiograph of the right hip is shown in Figure A. Which of the following surgical interventions is best indicated?
Single innominate osteotomy (Salter)
Double innominate osteotomy
Peri-acetabular osteotomy (Ganz)
Triple innominate osteotomy (Steele)
Which of the following concepts regarding pediatric hips is true?
The proximal femoral physis and greater trochanteric apophysis develop from different cartilaginous physes
The proximal femoral physis grows at a rate of 9 mm per year
Normal infant femoral anteversion is between 10-20 degrees
The ossific nucleus of the proximal femur is visible on radiographs by 6 months of age in most children
Slipped capital femoral epiphysis (SCFE) typically occurs through the zone of proliferation
Failure to achieve reduction of a dislocated hip in an otherwise healthy 4 month old infant which did not reduce after 3 weeks in a Pavlik harness and 3 weeks in an abduction brace is best treated with which of the following?
Adjusting the harness to 75 degrees of abduction and maintaing 90 degrees of hip flexion
Adjusting the harness to 75 degrees of abduction and increasing hip flexion to 120 degrees
Closed reduction with hip arthrogram, adductor tenotomy if necessary, and hip spica casting
Open reduction and femoral shortening osteotomy
Open reduction, femoral shortening osteotomy, and pelvic acetabular osteotomy
A 2-week-old infant girl is referred for a hip clunk noticed by the pediatrician. She has a history of a normal spontaneous vaginal delivery and is otherwise healthy. Examination demonstrates a right hip Ortolani sign. A coronal ultrasound is shown in figure A. What is the most appropriate next step in treatment?
Observation with repeat ultrasound in 1 month
Pavlik harness application
Closed reduction and spica casting
Open reduction and spica casting
Open reduction, acetabular osteotomy, femoral shortening, and spica casting
In patients older than 12-months of age with developmental dysplasia of the hip, all of the following physical exam findings are likely present EXCEPT?
Limited hip abduction
Positive Ortolani maneuver
Abnormal leg lengths on Galeazzi testing
Figures A-E show a series of radiographic lines used in the assessment of a paediatric hip joint. Which of the following figures shows Perkin's line?
In infants with developmental dysplasia of the hip (DDH), anatomic closed reduction may be prevented by all of the following anatomic structure EXCEPT.
Interposition of gluteus medius
Limbus formed by fibrous tissue and hyaline cartilage
Ligamentum teres and prominent fibrofatty pulvinar tissue
Contracted transverse acetabular ligament
Inverted acetabular labrum
A five-year-old boy with cerebral palsy presents to the clinic with a dislocated right hip, what quadrant of the acetabulum is most likely deficient?
Anterior-inferior and anterior-superior
Figure A depicts an ultrasound of a newborn infant's hip. Which of the following structures (1 through 5) represents the labrum?
Hip Deformity In The Young Adult-Scope Or Open?-Stephanie Pun ,MD (COA 2017,8.2)
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HPI - Girl with abnormal gait. Got treatment from "traditional healers " with out an X ray. Presented to us at her 8 yr of age because of pain.
What would be her management option?
HPI - this 4 yrs F is a known case of DDH diagnosed at age of walking ( 14 months old) & was treated 3 times by open reduction only & failed
what are the lines of management?
HPI - No childhood trauma, no infection, no inflammatory diseases
What is the plan of management ?