Osteotomies around the hip joint involve surgical procedures to correct biomechanical alignment of the extremity. Common types include femoral osteotomies, pelvic osteotomies, and intertrochanteric osteotomies. They work by improving joint congruity, increasing the weight bearing surface, and restoring normal biomechanics. Indications include developmental dysplasia of the hip, osteoarthritis, fractures, and deformities like coxa vara. Rigid internal fixation is often used to facilitate early mobilization and prevent complications.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. Osteotomies around Hip jointOsteotomies around Hip joint
Dr Gaurav Singh
Central Institute Of Orthopaedics
VMMC & SJH
2. DEFINITION
An osteotomy is a surgical corrective
procedure used to obtain a correct
biomechanical alignment of the extremity so
as to achieve equivocal load transmission,
performed with or without removal of a
portion of the bone.
3. BIO MECHANICS
Forces across hip joint
BW
Ground rection forces
Abductor muscle forces Improving abductor function will
decrease joint reaction forces
4. Why does Osteotomy work?
Osteotomies improve hip function
Increasing contact area / congruency
Improve coverage of head
Moving normal articular cartilage into weight bearing
zone
Restore biomechanical advantage / Decreasing joint
reactive forces
?? Stimulating cartilage repair
5. Contraindications to
Osteotomy
Neuropathic arthropathy
Inflammatory arthropathy
Active infections
Severe osteopenia
Advanced arthritis/ankylosis
Advanced age
*smoking, obesity
6. OSTEOTOMY AROUND HIP CLASSIFICATION
According to Anatomic Location
Femoral Osteotomy.
Subtrochanteric Osteotomy.
Greater Trochanteric.
High Cervical
Intertrochanteric Osteotomy
Pelvic Osteotomy.
Salvage Osteotomies : eg. Chiari, Shelf.
Reconstructive Osteotomies : eg. Periacetabular, Single,
Double, Triple Innominate.
7. Contd.
Based on Indications
To obtain stability
old unreduced dislocations.
Lorenz bifurcation osteotomy.
Schanz low subtrochanteric.
To obtain union
ununited fractures of femoral neck.
McMurry’s osteotomy.
Dickson's high geometric osteotomy.
Schanz Angulation Osteotomy.
unstable intertrochanteric fractures.
Dimon Hughston Osteotomy.
Sarmiento’s Osteotomy
8. Relief of pain
osteoarathritis.
Pauwel’s type I varus osteotomy.
Pauwel’s type II valgus osteotomy.
To Correct deformities
coxa vara
slipped upper femoral epiphysis
Intracapsular cuneiform osteotomy by dunn.
Compensatory Basilar Osteotomy of Femoral Neck.
Extracapsular Base-of-Neck osteotomy.
Ball-and-Socket Trochanteric Osteotomy.
Pauwel’s osteotomy (Y).
Contd.Contd.
9. In Osteonecrosis of femoral head
Sugioka’s transtrochanteric osteotomy.
Varus derotation osteotomy of Axer.
- In paralytic disorders of hip.
Varus Osteotomy.
Rotational Osteotomy
In congenital dislocation.
Contd.Contd.
10. SALTER OSTEOTOMY
INDI-Congruous hip reduction,<10-15 degrees correction of
acetabular index required ,paralytic disorder,subluxation after septic
arthritis
PREREQUISITES- femoral head must be positioned opposite the
level of acetabulum, contracture of iliopsoas and adductor
muscles must be released, range of motion of the hip must be
good specially in abduction , int. rotation flexion
PROC.- Single Innominate osteotomy
Acetabulum together with ilium and pubis rotated
Held by wedge of bone
AGE-18 months-6years
AFTERCARE-hip spica for 8 to 12 week,then partial weight bearing
on crutches ,followed by full weight bearing.result assesed by center
edge angle.
11.
12.
13.
14.
15.
16.
17.
18.
19. INDICATION- >10-15 degrees correction of acetabular index
required ,small femoral head ,large acetabulum.
ADV- internal fixation not required .greater degree of rotation can
be achieved with less rotation of acetabulum
DISADV- Technically more difficult . Alters the configuration and
capacity of acetabulum and produce joint incongruity that requires
remodeling
AGE-18months- 10 yr
AFTERCARE-spica cast for 8 to 12 weeks
PEMBERTON PERICAPSULAR OSTEOTOMYPEMBERTON PERICAPSULAR OSTEOTOMY
20. PEMBERTON OSTEOTOMY
PROCEDURE- Pemberton described a pericapsular osteotomy
of the ilium in which the osteotomy is made through the full
thickness of the bone from just superior to the anteroinferior iliac
spine anteriorly to the triradiate cartilage posteriorly : the
triradiate cartilage acts as a hinge on which the acetabular roof is
rotated anteriorly and laterally.
22. STEEL OSTEOTOMY
INDI-Adolescents and skeletally mature adults with residual
dysplasia and subluxation in whom remodelling of acetabulum is
no longer anticipated
ADV-Better coverage of femoral head by articular cartilage ,
Better hip joint stability, no need of spica cast.
DIS- Technically difficuilt, does not change size of acetabulum,
distort the hip such that natural child birth may be impossible in
adulthood
PROC-The ischium, the sup pubic ramus and ilium superior to
the acetabulum is reposition and stabilized by bone graft
24. GANZ OSTEOTOMY: (BERNESE)
PRIACETUBULAR OSTEOTOMY.
This Triplaner osteotomy is for adolescent and adult
dysplastic hip that required correction of congruency
& containment of the femoral head with little or no
arthritis.
If significant degenerative changes are presents a
proximal femoral osteotomy can be added.
Approach Smith Peterson approach.
26. Advantages :
Only one approach is used.
A large amount of correction can be obtained in all
directions, including the medial and lateral planes.
Blood supply to the acetabulum is preserved.
The posterior column of the hemipelvis remains
mechanically intact, allowing immediate crutch walking
with minimal internal fixation.
The shape of the true pelvis is unaltered, permitting a
normal child delivery.
Can be combined with trochanteric osteotomy if
needed.
Contd.Contd.
27. SHELF OPERATION (STAHELI)
Have commonly been performed to enlarge the volume of the
acetabulum.
The objective is to create a shelf, the size of which is decided by
measuring the “width of augmentation” form the CE angle. The
shelf is put just above the acetabular margin. It secure two layers
of cancellous grafts bringing the reflected head of rectus femoris
forward over the graft and suturing it in its original position.
Best to do after 5 years of age.
Indication : A deficient acetabulum that cannot be corrected by
redirectional, osteotomy is the primary indication.
Contraindication :
Dysplastic hip with spherical congruity suitable for
redirectional osteotomy
Hip requiring open reduction.
30. CHIARI OSTEOTOMY
PROC-It is performed at the superior margin of the
acetabulum and the pelvis inferior to the osteotomy
along with the femur is displaced medially.
This is also called as capsular interposition Arthroplasty
as the capsule is interposed between the shelf and the
femoral head.
INDI-incongruous joint, dysplastic hip with osteoarthritis ,
other osteotomy not possible
DISADV-salvage osteotomy only, leaves anterior
acetabulum uncovered,abductor lurch common .
34. OSTEOTOMY
Primary objective is deflection of wt. bearing by
angulation of femur to bring the axis of the
femoral shaft more in line with the direction of
weight transmission.
The osteotomy performed are Angulation
Osteotomy (Stabilizing osteotomy).
Schanz osteotomy.
Lorenz osteotomy.
35. SCHANZ OSTEOTOMY (LOW S/T OSTEOTOMY)
(a)(a)Femur is sectioned transversely a lower border of pelvis.Femur is sectioned transversely a lower border of pelvis.
(b)(b)Upper end is angled inward until it rest against side wall of pelvis.Upper end is angled inward until it rest against side wall of pelvis.
36. Schanz osteotomy (Low S/T Osteotomy) :
In this osteotomy the deformity flexion, adduction &
external Rotation is corrected by making the osteotomy at
tuber ischii level.
Preparation :
X-ray are taken with full adduction – to measure
angle medially.
Thomas Test - measure degree of flexion to be
corrected.
Advantages :
Lurching gait will be diminished.
The depression of the trochanter also improves the
leverage of the glutei.
Contd.Contd.
37. Contraindication : Before 15 years of age, because loss
of angulation during growth period.
Lorenz (Bifurcation osteotomy)
In this upper end of the lower fragment is abducted and
inserted in to the acetabulum after making on
intertrochanteric osteotomy “plane of osteotomy” below &
outward to above & inward.
Disadvantage :
Increased shortening.
Less mobility and arthritic pain.
Contd.Contd.
38. LORENZ (BIFURCATION OSTEOTOMY)
(A) Plane of
osteotomy – Distal
end at posterolateral
aspect towards
proximal end at
anteromedial aspect.
(B) Limb is Abducted(B) Limb is Abducted
and extended so proximaland extended so proximal
end of distal fragmentend of distal fragment
directed medially anddirected medially and
anteriorly in acetabulum.anteriorly in acetabulum.
39. OSTEOTOMY FOR COXA VERA
The normal femoral neck shaft angle in infant is 1200
to 1400
,
Reduction to a more acute angle constitute a coxa vara
deformity.
The goal of treatment are
To promote ossification of the defect and correct varus
deformity.
Indication for surgery :
Increasing coxa vara
Neck shaft angle less than 110°.
Painful unilateral or associated with leg length
discrepancy
Hilgenreiner - epiphy seal angle of more than 60° .
40. Surgery performed are
Valgus Subtrochanteric Osteotomy or abduction
osteotomy-with Internal Fixation.
A transverse osteotomy at about the level of lesser
trochanter.
If necessary take a small lateral wedge to correct
neck shaft angle to 135-150.
The surgery may be delayed till child is 4 to 5 year
old to make internal fixation easier.
Contd.Contd.
41. Alternative Method : Pauwels Y shaped osteotomy :
Static forces are converted from shearing to
impacting forces
Prerequisites :
Viable femoral head.
Young vigorous patient.
Advantage :
Union is rapid.
Recurrence is less likely.
Contd.Contd.
45. OSTEOTOMY FOR RELIEF OF PAIN IN
OSTEOARTHRITIS
Before the onset of osteoarthritis, if normal or near normal
function of the hip can be maintained, reconstructive
osteotomy can prevent or delay the development of
osteoarthritis; if mild or moderate osteoarthritis is present, a
salvage osteotomy can improve function and delay the need
for total hip Arthroplasty.
47. varus osteotomy
Designed to elevate the greater trochanter and move it
laterally while moving the abductor and psoas muscles
medially, to restore joint congruity and decrease muscle forces
about the hip.
Varus osteotomy alone is indicated for patients with a
spherical femoral head, little or no acetabular dysplasia
center-edge angle of at least 15 to 20 degrees), signs lateral
overloading, and a valgus neck-shaft angle of more than 135
degrees.
Varus osteotomy with medial displacement of the femoral
shaft relaxes the abductor, psoas, and adductor
musclesunloads the hip joint, and increases the weight-
bearing surface.
Contd.Contd.
48. Most authors recommend medial displacement of 10 to
15 mm to keep the ipsilateral knee centered under the
femoral head and to maintain the mechanical axis of the
leg.
Varus osteotomy, however, shortens the limb to some
degree. creates a Trendelenburg gait that may persist for
months after surgery, and increases the prominence of
the greater trochanter.
Limb shortening can be minimized by making a smaller
medial osteotomy and transposing it to the lateral side.
Contd.Contd.
54. VALGUS INTERTROCHANTERIC FEMORAL
OSTEOTOMIES
Valgus Osteotomy - Increase weight bearing area of femur
head.
It does not produce muscle relaxation.
Relaxation obtained by tenotomy of Iliopsos and adductor
muscle.
Transfer the center of hip rotation medially from the superior
aspect of the acetabulum to increase joint congruity and the
weight-bearing area of the femoral head.
Osteotomy of the greater trochanter often is performed with
valgus femoral osteotomy to move the greater trochanter
laterally.
55. Best result were obtained in patients younger than 40 years of
age with unilateral involvement, good preoperative range of
motion, and a mechanical (secondary) cause.
Unsatisfactory results occurred in patients with limited
preoperative flexion, they cited preoperative flexion of less than
60 degrees as a relative contraindication to valgus osteotomy.
Most surgeons now advise that all osteotomies be fixed with rigid
internal fixation, which offers several obvious advantages:
The fragments are maintained in proper position;
The danger of limitation of motion of the hip and knee is
greatly decreased;
Contd.Contd.
56. The patient can be allowed out of bed early; and
Pulmonary, urological, and other medical complications
are decreased. A device frequently used for rigid internal
fixation of intertrochanteric osteotomies is the ASIF, or
right-angled, blade plate. Our experience with this device
has been quite favorable.
Nonunion has been a troublesome complication after
Osteotomy, and an incidence as high as 20% has been
reported.
Contd.Contd.
62. OSTEOTOMY TO CORRECT UNSTABLE
INTERTROCHANTERIC FRACTURES
Dimon and Hughston :
Described technique of Trochanteric osteotomy with
valgus nailing and medial displacement to improve
stability there techniques are occasionally useful in
some extremely comminuted fractures.
Recent studies have indicated that anatomical reduction
allow greater load shearing by bone than medial
displacement osteotomy.
64. SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
Is a disorder in which there is a displacement of the capital
femoral epiphysis form the metaphysis through the physeal
plate.
By this head is placed in posterior & downward position in
acetabulum.
The goal of treatment is
To prevent further displacement and
To promote closure of physeal plate.
65. The use of realignment procedure such as lntertrochameric,
Subtrochanteric Osteotomy & osteotomies the around neck is
in those situation in which restricted range of motion impairs
function after plate physeal closure.
Principle of Osteotomy
There are basically three type of Deformity present in SCFE.
These are-
Varus
Hyper extension
Moderate Severe external rotation
Contd.Contd.
66. SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
The osteotomy to correct theseThe osteotomy to correct these
deformities work at two sites.deformities work at two sites.
Through the femoral neckThrough the femoral neck
(closing wedge osteotomy)(closing wedge osteotomy)
Through the trochantericThrough the trochanteric
area.area.
67.
68. EXTRACAPSULAR BASE OF NECK
OSTEOTOMY
types of femoral neck osteotomy are -
The technique of Dunn - for severe chronic slip with open
physis.
Base of the neck osteotomy - Compensatory Basilar
most of femoral neck. (Kramer) - correct the varus and
retroversion component of moderate to severe chronic
SCFE.
It is safer than cuniform osteotomy of neck.
Further slipping is prevented.
Intertrochantric osteotomies
69. CORRECTIVE OSTOTOMIES
By these osteotomies one can correct angulation, rotation,
flexion, extension Deformity of bones to restore motion for
patient with stiff hip.
Like
Deformities in septic arthritis
Malunion of I/T femurs
Neuromuscular disorder
Cerebral palsy
Poliomyelitis
70. There are three types of corrective osteotomies
Close wedge - transverse closing wedge provide good
bony apposition and is stable, however, it shortens the
extremity.
Open wedge - simple and lengthens the extremity
however. bony apposition is limited, union is delayed in
adults and it is initially unstable.
Ball and Socket type - achieves stability without
shortening the extremity; however, extensive dissection is
required, and in severe biplame deformities an accurate
and stable osteotomy is difficult to perform.
In Ball & socket type of osteotomy concave surface in created in
the proximal fragment of convex surface at the distal fragment,
at intertrochantaric level & fixed in place by plate.
Contd.Contd.
72. FRACTURE NECK FEMUR
In those case which present late (1-5 wks.), are difficult case to
treat because
Close reduction is not possible.
Open reduction is associated AVN
In young Pt. with viable femoral head & nonunion options are-
Mcmurray & Pauwel’s ‘y’ osteotomy
Angulation Osteotomy (Schanz)
Dickson geometric osteotomy
In old Pt.-
Girdle stone osteotomy
Mcmurray Displacement
73. MC-MURRAY’S OSTEOTOMY
The oblique osteotomy extends from the lateral aspect of
the shaft at a level just below the lower border of the lesser
trochanter and lower border of neck.Then the limb is
rotated inward and outward to remove any bony spike
Fixation of osteotomy - By Compression nail
plate./Castle Plate.
Disadvantages:
Instability - Degenerative changes in normal head
Shortening - AVN when neck have been fractured
Medial displacement of shaft compromise the
insertion of femoral stem of total hip.
Advantage -Changes line of fracture to horizontal,callus
may incarporate fracture
75. DICKSON HIGH GEOMETRIC OSTEOTOMY
Principle - the line of vertical force is
converted to a horizontal (impacting
force). In this distal fragment is
abducted to 60° after making
osteotomy just below the grater
trochanter & fixed with plate.
High rate of union
Lengthens limb
Improves abductor strength
76. GIRDLE STONE OSTEOTOMY
In this head & neck of femur are excised at Inter trochanteric
level to create pseudo arthrosis in order to improve stability.
Angulations Osteotomy is added.
Indication
T.B. Hip
Pyogenic Hip
Non union #.neck femur [in elderly pt.]
AVN of femoral head.
Advantages :-
Painless mobile hip joint.
79. OSTEOTOMIES –
These procedure have achieved best result for small and
medium sized lesion. 1<30% femoral head involvement in
young pt.
Intertrochanteric varus/valgus - osteotomies
Transtrochantric ant. Rotational osteotomy (Sugioka) -
Technically Demanding procedures.
PRINCIPLE:
All osteotomies are designed to transfer the weight
bearing forces form the necrotic area to the cartilage on
the sound part of the femoral head to allow healing of
necrotic area by hyper vascularisation of upper part of
femur.
AVNAVN
81. TECHNIQUE FOR ROTATION
Femoral head is rotated anteriorly (450
- 900
) by handling
proximal pin.
82. OSTEOTOMY IN PERTHE'S DISEASE
Salvage :
Varus Derotational Osteotomy
Innominate Osteotomy.
Combined Procedure -
MRI / Arthrogram before surgery is mandatory.
Varus/derotation osteotomy of this embodies the principle
of “containment” of the diseased femoral head in the
treatment of Legg - Calve-Perthes disease.
Guide pin inserted compression screw is placed over
guide wire.
84. Appropriate angled osteotomy is made.
Wedge is removed.
Make osteotomy as proximal as possible just below lag
screw for -
Better Healing
Better correction of deformity.
Reduce the osteotomy and fixed with plate and
compression screw.
Contd.Contd.
85. SUBTROCHANTERIC DEROTATION AND
VARUS OSTEOTOMY
The aim of surgery is to center the whole "plastic" epiphysis
inside the joint cavity, keeping it well covered by the roof of the
acetabulum and allowing the child to walk so that the
redistributed intra-articular pressures will contribute the molding
of a more normal joint.
A small 4-hole plate is bent to the desired angle, and a
subtrochanteric osteotomy is done followed by derotation and
yarns angulation of the shaft. A double hip spica is applied and
the removed 2 months later. When the osteotomy site is united,
the child is encouraged to walk, at first in warm water pool, then
with walking aids and finally without support.
87. The operation is best suited for early stage of Leg-Calve-
Perthes’ disease, preferably those under the age of 7 years.
Axer : Described lateral open wedge osteotomy for children <
5 years with perthes disease. Defect laterally fills rapidly in
young children > 5 years of age delayed or non union may
occur.
Contd.Contd.
88. RECONSTRUCTIVE SURGERY
Valgus subtrochanteric osteotomy - for Hing
Abduction
Shelf Augmentation – Coxa Megna.
Chilectomy - Malformed head in late III Group.
Chiar's Pelvic Osteotomy - Large Malformed
Femoral Head with Subluxation laterally.
89. BIBLIOGRAPHY
Apley's System of Orthopaedics and Fractures - Loui's Soloman
8th Edition.
Campbell's Operative Orthopaedics - 11th Edition. Vol.-2.
Text Book of Orthopaedics - John Ebnezar - IInd Edition.
Orthopaedic Knowledge Update – 7.
Samuel L Turek Orthopaedics principles & their applications
volume