orthonotes57

ddh salter inominate dega pemberton new variation AIO = kalamchi eren sanchez percutaneous sanchez
mesa yamhure eren

Immediate postspica MRI with gadolinium is a useful prognostic tool for determining future risk for epiphyseal osteonecrosis in children treated for DDH.

https://journals.lww.com/jpo-b/Abstract/2019/09000/Spica_MRI_predictors_for_epiphyseal_osteonecrosis.2.aspx
Epiphyseal osteonecrosis was more likely with less than 80% enhancement

(sensitivity 87.5%, specificity 88.25%, positive predictive value 78%, negative predictive value 94%).
The mean contrast enhancement for patients developing osteonecrosis compared with those who did not was 37.5 and 86.5%, respectively; P = 0.001.

Proposal of a New Type of Innominate Osteotomy without the Use of Bone Graft in Children
A Preliminary Study

Morita, Mitsuaki MD, PhD1; Kamegaya, Makoto MD, PhD1;
Takahashi, Daisuke MD, PhD2;
Kamada, Hiroshi MD, PhD3; Tsukagoshi, Yuta MD, PhD3;
Tomaru, Yohei MD3
JBJS Open Access: July-September 2019 - Volume 4 - Issue 3 - p e0016
doi: 10.2106/JBJS.OA.19.00016
AIO (“angulated innominate osteotomy”).is a less-invasive procedure that does not require a bone graft, and the short-term outcomes were favorable. Sufficient coverage of the acetabulum with displacement of the distal bone fragment to an extent similar to SIO can be achieved; we consider AIO a worthy surgical procedure that has the potential to provide good long-term outcomes similar to those seen with SIO.
In SIO, the bone is cut in a straight line from the sciatic notch to a point immediately superior to the anterior inferior iliac spine; however, in AIO, the line is raised approximately 30° proximal to the Salter osteotomy line, with the center of the osteotomy line as the vertex, and then an angulated osteotomy is made to a point immediately superior to the anterior inferior iliac spine to form an isosceles triangle (Fig. 2). This osteotomy angle was set on the basis of results obtained through biomechanical analysis of the Salter method in a study by Rab, which produced correction with a bend of approximately 30°^⁷.

In reality, when performing the osteotomy, it is vital to first identify the vertex. The vertex is on a perpendicular line proximal to the midpoint of the distance from the sciatic notch to a point immediately superior to the anterior inferior iliac spine (original Salter osteotomy line) and is placed at the distance obtained with the formula shown in Figure 2.
After osteotomy, the distal bone fragment is rotated distally as done with an SIO and fixed with 3 to 4 wires (one 3-mm-diameter threaded Kirschner wire and two to three 2-mm-diameter Kirschner wires).
During this process, the distal bone fragment is maneuvered anterolaterally to ensure that the outer wall of the proximal bone fragment is in contact with the inner wall of the distal bone fragment. This manipulation creates 2 points of contact between the proximal and distal bone fragments, thereby enabling stable fixation and good bone-healing without the use of a bone graft (Fig. 3).

https://pdfs.semanticscholar.org/784a/24e40fc4228505542861d1c5bec242e05e9a.pdf?_ga=2.104751301.41221310.1585982034-115253843.1585982034

Eren A, Pekmezci M, Demirkiran G, Cakar M, Guven M, Yazici M. Modified Salter osteotomy for the treatment of developmental dysplasia of the hip: description of a new technique that eliminated the use of pins for internal fixation. J Bone Joint Surg Br. 2007 Oct;89(10):1375-8.
Sanchez Mesa PA, Yamhure FH. Percutaneous innominate pelvic osteotomy without the use of bone graft for femoral head coverage in children 2-8 years of age. J Pediatr Orthop B. 2010 May;19(3):256-63.

Percutaneous innominate pelvic osteotomy without the use of bone graft for femoral head coverage in children 2-8 years of age.

Per-cutaneous innominate pelvic osteotomy without the use of bone graft as treatment for hip diseases is proposed as another tool to handle this pathology, which occurs frequently in our area, without changing postural correction at the level of the pelvis by secondary trans-iliac lengthening through an unilateral iliac bone graft at the lower extremity. This technique was developed by bio-mechanical studies in corpses and was later performed on children.

This was a prospective, multi-centric, longitudinal study of a case series in children between 2 and 8 years of age with developmental hip dysplasia, Legg-Calve-Perthes disease, aseptic or avascular necrosis, congenital or acquired lesions of the femoral head having obtained previous consent from the parents.
In 121 patients with increases in femoral head coverage in a concentric hip joint, the average follow-up period was 4.1 years (range 6 months to 5 years). The vertical-center-anterior angle of Lequesne and the center-edge angle of Wiberg, both of which showed significant improvement in the coverage of the femoral head with an average of acetabular pre-surgical index of 38.2 degrees (P=0.002) and a post-surgical average of 19.8 degrees (P=0.003), angles of lateral uncovering of the femoral head of 12.3 degrees (P=0.0019) and a postsurgical angle of 23.2 degrees (P=0.004). The registered complications were 2.7% (P=0.047).
The results offer many advantages over the current treatments on handling congenital diseases or acquired diseases of the hip and can indicate an alternative to the other methods of treatment which is possibly less aggressive and with a better future for the patient.

https://www.researchgate.net/publication/41174125_Percutaneous_innominate_pelvic_osteotomy_without_the_use_of_bone_graft_for_femoral_head_coverage_in_children_2-8_years_of_age?
https://www.semanticscholar.org/paper/Percutaneous-innominate-pelvic-osteotomy-without-of-Mesa-Yamhure/7cf472b3124fae15623bd1317510070837343880/figure/5 Published in Journal of pediatric orthopedics. Part B 2010 Percutaneous innominate pelvic osteotomy without the use of bone graft for femoral head coverage in children 2-8 years of age.

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