Osteotomies are surgical procedures used to correct biomechanical alignment of the extremities. There are several types of osteotomies around the hip joint classified by anatomic location including femoral and pelvic osteotomies. Common indications are to correct deformities, obtain stability, relieve pain, and obtain union. Key pelvic osteotomies discussed include Salter, Pemberton, Steel, Ganz, shelf, and Chiari osteotomies. Careful pre-operative planning including x-rays and range of motion assessment is important for determining the appropriate procedure.
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
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
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
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
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Incision or transection of bone.
Uses:-
to correct deformity.
to change shape of bone.
to redirect load trajectories in a limb so as to influence joint function.
Surgical approaches in orthopaedics- General principlesDr.A.Mohan krishna
This is a short educational presentation fresh junior registrars in orthopaedics covering general principles of surgical approaches in orthopaedics.
The presentation gives brief idea of surgical principles to be followed while preparing for general orthopedic surgeries.
APPROACHES OF ILIUM, PUBIC SYMPHYSIS & SACROILLIAC JOINTCHAUDHARY ARPAN
THIRD YEAR PG RESIDENT,
M.S. ORTHOPAEDICS
muscles of the thigh, Gluteus medius, Gluteus maximus, Tensor fascia lat, Anterior and posterior Illium approaches for grafting, Anterior approach to the iliac wing and SI joint.
Anterior approach to the iliac wing and SI joint,
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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
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.
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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.
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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!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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,
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In the DSM-5, all types of substance abuse and dependence have been
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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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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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. OSTEOTOMY AROUND HIP -
CLASSIFICATION
According to Anatomic Location
Femoral Osteotomy
High Cervical.
Intertrochanteric Osteotomy.
Subtrochanteric Osteotomy.
Greater Trochanteric
Pelvic Osteotomy
Salvage Osteotomies : eg. Chiari, Shelf,
Reconstructive Osteotomies : eg. Periacetabular, Single,
Double, Triple Innominate
Combined Osteotomy
4. INDICATIONS
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).
5. To obtain stability
old unreduced dislocations.
Lorenz bifurcation osteotomy.
Schanz low subtrochanteric.
Relief of pain
osteoarathritis.
Pauwel’s type I varus osteotomy.
Pauwel’s type II valgus osteotomy.
6. To obtain union
Un-united fractures of femoral neck.
McMurry’s osteotomy.
Dickson's high geometric osteotomy.
Schanz Angulation Osteotomy.
unstable intertrochanteric fractures.
Dimon Hughston Osteotomy.
Sarmiento’s Osteotomy
7. In Osteonecrosis of femoral head
Sugioka’s transtrochanteric osteotomy.
Varus deroation osteotomy of Axer.
- In paralytic disorders of hip.
Varus Osteotomy.
Rotational Osteotomy
8. In congenital dislocation of hip
Salters innominate osteotomy
Pembertons innominate ostetomy
Steels triple innominate osteotomy
Shelf operation
Chiari’s osteotomy
19. SALTER OSTEOTOMY
INDICATIONS-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
AGE-18 months-6years
AFTERCARE-hip spica for 8 to 12 wks,then partial weight
bearing on crutches ,followed by full weight bearing.result
assessed by center edge angle.
20. xrays
Salter osteotomy for congenital dislocation of hip. A, Residual
acetabular dysplasia and subluxation of right hip in 4-year-old
girl in whom open reduction had been performed at 9 months
of age. B, One year after repeat open reduction and Salter
innominate osteotomy.
21. 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. Pemberton pericapsular osteotomy. A, Line of osteotomy beginning slightly
superior to anterior inferior iliac spine and curving into triradiate cartilage.
B, Completed osteotomy with acetabular roof in corrected position and
wedge of bone impacted into open osteotomy site.
24. 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 produces
joint incongruity that requires remodelling
AGE-18months- 10 yr
AFTERCARE-spica cast for 8 to 12 weeks
PEMBERTON PERICAPSULAR OSTEOTOMY
25. PERIACETABULAR OSTEOTOMY OF ILIUM
(PEMBERTON)
Pemberton acetabuloplasty. A, Symptomatic residual acetabular
dysplasia in 8-year-old girl after treatment of congenital dislocation of
right hip. B, After Pemberton acetabuloplasty
27. STEEL OSTEOTOMY
The ischium, the superior pubic ramus and ilium superior to
the acetabulum are all divided and acetabulum is repositioned
and stabilized by bone graft and metal pins
Objective- To establish a stable hip in anatomical position for
dislocation or subluxation of the hip in older children when
this is impossible by any one of the other osteotomies
For the operation to be successful, the articular surfaces of the
joint must be congruous or become so when the acetabulum
has been redirected so that a functional, painless range of
motion is achieved and a Trendelenburg gait is absent
28. STEEL OSTEOTOMY
INDICATIONS-Adolescents and skeletally mature adults with
residual dysplasia and subluxation in whom remodelling of
acetabulum is no longer anticipated
ADVANTAGES-Better coverage of femoral head by articular
cartilage. Better hip joint stability,no need of spica cast.
DISADVANTAGES- Technically difficult, does not change
size of acetabulum, distorts the hip such that natural child birth
may be impossible in adulthood
29. STEEL OSTEOTOMY
A, Osteotomies to be performed in iliac wing and superior and
inferior pubic rami. Note wedge of bone to be taken as graft from
superiormost portion of ilium.
B, Lateral view showing graft in place and fixation with two
Kirschner wires.
30. STEEL OSTEOTOMY
Steel triple innominate osteotomy.
A, Sixteen-year-old girl with painful
right hip, subluxation, and
acetabular dysplasia. B, After Steel
osteotomy. C, One year after
surgery
A
B
C
31. 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 present a
proximal femoral osteotomy can be added.
Approach- Smith Peterson approach.
34. 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.
36. 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” from the CE angle. The
shelf is put just above the acetabular margin. It secures 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.
37. The placement of the acetabular slot is the
most critical part of the procedure; the slot
must be created exactly at the acetabular
margin
Approach- Iliofemoral approach using bikini
incision parallel and 1cm below the Iliac crest
39. CHIARI OSTEOTOMY
PROCEDURE-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.
INDICATIONS-incongruous joint, dysplastic hip with
osteoarthritis ,other osteotomy not possible
DISADVANTAGE-salvage osteotomy only, leaves
anterior acetabulum uncovered,abductor lurch common .
40. A, Line of osteotomy extending from immediately superior to
lip of acetabulum into sciatic notch. Osteotomy can be curved
to facilitate femoral head coverage. B, Completed osteotomy
with medial displacement of distal fragment for
interpositional capsular arthroplasty
42. PALLIATIVE OPERATION
Reserve for cases is which reduction is not possible by
either open or closed reduction as in old unreduced
congenital dislocation.
Designed to improve :
Stability.
Decrease lordosis.
Control pain arising from lower back/hip.
43.
44. SURGICAL PLANNING
In surgical planning of an osteotomy, the most
important task is to determine whether the
patient is an appropriate candidate.
Determining factors are the patient’s age,
activities, goals, radiographic assessment,
range of motion, and leg lengths and the status
of the knee of same side.
45. FEMORAL 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.
46. SCHANZ OSTEOTOMY (LOW Subtrochanteric
OSTEOTOMY)
(a)Femur is sectioned transversely a lower border of pelvis.
(b)Upper end is angled inward until it rest against side wall of pelvis.
47. Schanz 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.
48. 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.
49. LORENZ (BIFURCATION OSTEOTOMY)
(A) Plane of
osteotomy – Distal
end at posterolateral
aspect towards
proximal end at
anteromedial aspect.
(B) Limb is Abducted
and extended so proximal
end of distal fragment
directed medially and
anteriorly in acetabulum.
50. OSTEOTOMY FOR COXA VARA
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° .
51. 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.
52. 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.
56. 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.
57. Factors Reconstructive Osteotomy Salvage Osteotomy
Age Generally < 25 years Generally < 50 years (Some
biological Plasticity
Remains)
Symptoms Minimal Moderate to Severe
Motion Near Normal > 600 Flexion
Function Near Normal Fair to Poor
Pathoanatomy No Irreversible Changes Irreversible Changes
Roentgenography Congruent but Malaligned
Surfaces
Cartilage narrowing or
incongruity or both
Prognosis if
untreated
Poor Poor
THERAPEUTIC INTERVENTION IN HIP DIEASE
:RECONSTRUCTIVE VERSES SALVAGE OSTEOTOMY
58. The goal of reconstructive osteotomies, femoral or pelvic, is to
restore as nearly normal anatomy as possible, thus returning
joint pressures and loading patterns to normal.
The goal of salvage osteotomies are to relieve pain and
improve function enough to delay the need for total hip
Arthroplasty, especially in active patients younger than 50
years of age.
59. Pre –op planning
Xrays of hip in maximum adduction and
abduction.
Tenotomy if necessary
Determine in which position the head attains
best fit with the acetabulum
Range of abduction and adduction will
determine the angle of the wedge so that the
limb can attain in the neutral position
60.
61. 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.
Indications- patients with a spherical femoral head, little or no
acetabular dysplasia center-edge angle of at least 15 to 20
degrees),a valgus neck-shaft angle of more than 135
degrees,fixed abduction deformity.
C/I-fixed ext. rotation >25 deg,flexion of 70 deg
Varus osteotomy with medial displacement of the femoral
shaft relaxes the abductor, psoas, and adductor muscles
unloads the hip joint, and increases the weight-bearing surface.
62.
63.
64.
65.
66. Varus osteotomy increases weight bearing area of femoral head
while relaxing all three important muscle groups around hip joint
67. Three types of wedges cut for varus osteotomy. A, Original technique of Pauwels with proximal
osteotomy made transversely at distal end of greater trochanter. This type of osteotomy makes
it more difficult to correct rotation and to use right-angled blade plate. B, Original Müller
technique of excision of wide wedge based medially with distal osteotomy cut transversely
across shaft at just above level of lesser trochanter. C, Later technique of Müller using small
half wedge cut medially and transposed laterally.
69. 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.
70.
71.
72.
73.
74.
75. 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.
76. INDICATIONS : FIXED ADDUCTION
DEFORMITY
CONTRAINDICATIONS : FLEXION OF
LESS THAN 60 DEGREES, KNOCK KNEES
77. 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.
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;
78. 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.
Nonunion has been a troublesome complication after
Osteotomy, and an incidence as high as 20% has been
reported.
79. BIOMECHANICAL TREATMENT OF
OSTEOARTHRITIS
Therapy must be directed at reducing joint loads. This may
be by reducing the compressive forces directly or by
increasing the weight- bearing area, and thereby reducing
the load per unit area or ideally by combination of the two.
80. WHILE PERFORMING OSTEOTOMY
The distal cut must be perpendicular to the axis of the shaft
fragment.
All cortical wages are taken form the proximal fragment to
avoid loss of apposition when the distal fragment is rotated.
General contraindication of femoral osteotomies -
Poor motion
Inflamatory joint condition
Significant metabolic disease.
Severe degenerative joint disease.
82. 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.
84. 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.
85. 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
86. SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
The osteotomy to correct these
deformities work at two sites.
Through the femoral neck
(closing wedge osteotomy)
Through the trochanteric
area.
87.
88. 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
89. 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
90. 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.
92. 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.-
Mcmurray Displacement
93. OBLIQUE OSTEOTOMY
Extends from lateral aspect of shaft at level just below the
lower border of lesser trochanter and terminates medially
between lesser trochanter and lower border of neck.
Shaft is displaced medially.
Mechanical Advantage :-
Line of weight bearing shifted medially.
Shearing forces at the nounion is decrease because
fracture surface become more horizontal
These advantages are greater after angulation osteotomy.
96. 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
97. 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
98. 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.
AVN
100. TECHNIQUE FOR ROTATION
Femoral head is rotated anteriorly (450 - 900) by handling
proximal pin.
101. OSTEOTOMY IN PERTHE'S DISEASE
Salvage :
Varus Derotational Osteotomy
Innominate Osteotomy.
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.
102. 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.
103. 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, then with walking aids
and finally without support.
105. 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.
106. RECONSTRUCTIVE SURGERY
Valgus subtrochanteric osteotomy – for Hinged
Abduction
Shelf Augmentation – Coxa Magna.
Chilectomy - Malformed head in late III Group.
Chiari's Pelvic Osteotomy - Large Malformed
Femoral Head with Subluxation laterally.