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Management of DDH in children between age of (1-2.5) years old by open reduction & derotation osteotomy without pelvic osteotomy

Authors: Raed Abbas Saadoon --- Mohammed Jafer Jawad
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 1-8
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background; Developmental dysplasia of the hip (DDH) means femoral head subluxation or dislocation and/or acetabular dysplasia. Management of neglected (DDH) in children after the walking age is challenging to the orthopedic surgeons. It is usually surgically demanding procedures at this age group. There will be always children who reach walking age with DDH, either secondary to failed treatment or delayed diagnosis. Aims: To evaluate the results of open reduction & derotation osteotomy in treatment of DDH in children without pelvic osteotomy. Methods: At the Orthopedic Department in AL-Yarmook hospital from the period of December 2010 to November 2015. Twenty-three patients (3 patients had bilateral DDH) [26 hip joints] with DDH, the age of patients at time of the operation ranged from (12-30) months, treatment done in two stages open reduction (1st stage) and derotation osteotomy of femur (2nd stage), except Five cases, we did open reduction, shortening & derotation osteotomy in one session because of difficulty in reduction. Final functional & clinical evaluation of patients were done according to a combination of modified MacKay criteria and modified Harris hip score. Radiological evaluation at the end of follow-up was done according to the modified Severin radiographic criteria. Results: - The overall final clinical results were excellent in 8 hips (30.8%), good in 16 hips (61.6%), fair in one hip (3.8%) and poor in one (3.8%), satisfactory (excellent and good) in 24hips (92.3%) and unsatisfactory (fair and poor) in 2 hips (7.7%).The radiological end result was Class I (excellent) in 15 hipss (57.7%), Class II (good) in 10 (38.5%), Class III (fair) in one (3.8%). The results were satisfactory in 25 (96%) hips and unsatisfactory in one (4%) hip. Conclusion: We concluded that operative treatment of neglected DDH ( after the age of walking ) is a surgically demanding procedure but when it performed properly by an open reduction & derotation osteotomy with spending good time for cleaning of acetabulum & excise part of capsule with secure capsulorraphy without need for pelvic osteotomy for those children below age of 2.5 years old.


Article
External Fixation with Supplementary Intramedullary Kirschner Wires in the Treatment of Unstable Distal Radial Fractures
علاج كسر اسفل عظم الكعبره (غير المستقر) باستخدام جهاز التثبيت الخارجي المدعم بالكي واير

Author: Mohammed Jafer Jawad Al-Musawi محمد جعفر جواد الموسوي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 1 Pages: 85-92
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: External fixation is a popular method to reduce osseous deformity of the distal radius, but cannot assure maintenance of the reduction. Supplementing external fixation with intramedullary Kirschner wires can improve retention of fracture reduction during healing, resulting in better functional results.Objectives: To determine radiographic and functional outcomes in unstable distal radius fracture treated by close reduction and external fixation, with supplementary intramedullary Kirschner wires.Patients & methods: 26 distal radius fractures were treated with external fixation supplemented with intramedullary wires. The fractures were evaluated via good-quality posteroanterior and lateral radiographs. The radial height, radial inclination and volar tilting were measured on initial (preoperative) and immediate postoperative radiographs and on others taken immediately after the removal of external fixation. Overall results were based on objective radiographic and functional data as well as on subjective assessments with demerit-point scoring. Results: In our study ,we found that there is a great relationship between radiological restoration of the length of distal radius and functional outcome ,using the Dermerit point-rating system ,we found that 23 patients (89% ) had excellent or good result ,2 patients (8%) were classified as fair ,and 1 patients (3%) had poor results. Radial height, volar tilt of distal radius deformity and radial inclination improved significantly immediately after surgery, when external fixation was supplemented with intramedullary Kirschner wires. Clinical examination likewise found significantly better functional results regarding range of motions & grips strength.Conclusion: External fixation is a popular method to reduce osseous deformity of the distal radius, but cannot assure maintenance of the reduction. Supplementing external fixation with intramedullary Kirschner wires can improve retention of fracture reduction during healing, resulting in better functional results.Keywords: Unstable distal radius, external fixation, K-wires

الملخصالخلفيه البحثيه: استخدام جهاز التثبيت الخارجي المدعم بالكي واير لعلاج كسر عظم اسفل الكعبره (غير المستقر) والذي فيه تفت ظهري او زيحان كبير او امتداده لمفصل الرسغ من اجل الحصول على نتائج شعاعيه وسريريه جيده لايمكن الحصول عليها باستخدام طرق علاجيه اخرى الهدف: تقييم دور جهاز التثبيت الخارجي المدعم بالكي واير في علاج كسر اسفل عظم الكعبره (غير المستقر).طريقه العمل: استخدمت في هذه الدراسه 26 مريض في مستشفى اليرموك للفتره من كانون الاول 2009 لغايه اب 2011 وقد تراوحت اعمار المرضى مابين 52 للاناث و31 سنه للذكور وبمعدل 46 سنه وكان عدد مرضى الذكور 11 والاناث 15 وقد اجريت الفحوصات الشعاعيه لهم قبل العمليه وبعد العمليه مباشره وبعد رفع جهاز التثبيت الخارجي والداخلي وقد اعتمدت نتائج الدراسه على (حرزدرمت) لغرض معرفه النتائج النهائيه للمرضى النتائج: أظهرت الدراسة أن هناك علاقة كبيرة بين نتائج الفحوصات الشعاعية لأسترجاع الشكل الطبيعي لنهاية عظم الكعبرة والوظيفة الطبيعية له فيما يخص استرجاع حركة مفصل الرسخ وانقباض اليد, وبأستخدام حرز درمت أظهرت النتائج النهائية لـ (25) من المرضى المصابين بكسور غير مستقرة في أسفل عظم الكعبرة حيث كانت النتائج مرضية (جيد او ممتاز في 23 مريض) (89ٍ%) وكانت (مناسبه في 2مريض) (8%) وكانت (غير مناسبه في 1مريض) (3%) حيث تم استخدام جهاز التثبيت الخارجي المدعم بالكي واير لغرض التثبيت.الاستنتاج: استخدام جهاز التثبيت الخارجي المدعم بالكي واير يعطي نتائج جيده شعاعيا وسريرا وهي طريقه مناسبه للتقليل من التشوهات والاختلاطات التي تحدث لكسر اسفل عظم الكعبره (غير المستقر) نتيجه استخدام طرق علاجيه اخرى حيث ان دعم جهاز التثبيت الخارجي يساعد في تحسين وارجاع الكسر من غير مستقر الى مستقر والحفاظ عليه خلال فتره بناء الكسر وبالتالي يعطينا نتائج سريريه جيده

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