Technical Problems to Avoid in Performing Open Reduction of DDH

Slides:

Advertisements

Similar presentations

MC, 26yo male Unrestrained driver Late night accident

Advertisements

HIP COMPLEX. Review Bony Articular Surfaces Synovial ball and socket joint: Synovial ball and socket joint: Femoral head. Acetabular fossa. Lunate surface.

HIP JOINT By: Dr. Mujahid Khan.

Hip Joint Rania Gabr.

Anatomy Jeopardy Tom Gest, PhD Division of Anatomical Sciences University of Michigan Medical School Lower Limb Review with.

Posterior intramuscular septum

Dr. Iman Abdel Aal.

Muscles of Thigh Dr. Sama ul Haque.

Video: Hip Arthroscopy

Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum similar.

The Hip Presented by: Dan McReynolds Tracy Reed Lance Best

Femoral neck fractures Borrowed heavily from OTA core curriculum Authors: Steven A. Olson, MD and Brian Boyer, MD Kenneth J Koval, MD.

Joints of the lower limb

HIP JOINT …..the largest joint in the body Dr. Zeenat Zaidi.

Muscles of thigh D.Rania Gabr D.Sama. D.Elsherbiny.

HIP JOINT Prof. Saeed Makarem.

In the name of GOD THA & DDH By : paisoudeh karim MD Firoozgar hospital Iran university of medicine.

Assessment of Femoral Head and Head-Neck Junction Perfusion Following Surgical Hip Dislocation Using Gadolinium-Enhanced Magnetic Resonance Imaging: A.

by Morteza Kalhor, Martin Beck, Thomas W. Huff, and Reinhold Ganz

GNK 483 MUSCULOSKELETAL CONDITIONS BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012.

Lower Extremity Introduction. Hip Joint  Head of the femur with acetabulum of innominate  Ball in socket  Better union than shoulder  Acetabular labrum.

The Hip Joint Type: Synovial (Ball & Socket) Articular Surfaces: head of femur & acetabulum.

Dr.Amjad shatarat Adductor canal (Subsartorial) or Hunter’s canal Adductor canal (Subsartorial) or Hunter’s canal John Hunter described the exposure and.

Objectives Know the type and formation of hip joint. Differentiate the stability and mobility between the hip joint and shoulder joint. Identify the muscles.

The Hip Anatomy Mazyad Alotaibi. Joint complex Hip – ball and socket Closely associated the SIJ and lsp Movements – flex, ext, MR, LR, add and abd Joint.

Hip joint D.Rania Gabr D.Sama. D.Elsherbiny. Objectives Know the type and formation of hip joint. Differentiate the stability and mobility between the.

Valgus TKA: Balancing Technique

ANATOMY OF THE HIP Presented By: Cassie Litzinger, Julia Meyer,

5th December 2016 Anatomy Lecture By: Dr Anita Rani

ANTERIOR & MEDIAL COMPARTMENTS OF THIGH

Bones of the Hip.

Fractures of the Leg and Management

Developmental dysplasia of the hip

ANTERIOR & MEDIAL THIGH

Anatomy of the Pelvis and Hip.

Abdominal wall Abdominal muscles.

Developmental dysplasia of the hip

The anterior compartment of the thigh

Deep Structures of the Anterior Leg

5th Semi Annual POSNA/SLAOTI/EPOS

A. G. Sterian. , C. Dumitrescu. , M. B. Popescu. , M. Carp. , C

INDICATIONS AND TECHNIQUE OF CLOSED REDUCTION TREATMENT

Published in J Ped. Orthop B 2005

Abdominal wall Abdominal muscles.

ANTERIOR & MEDIAL COMPARTMENTS OF THIGH

Problematic Restricted Hip Motion Post Pelvic Osteotomy

Pelvic cavity. Gross anatomy of the lower limb. Walking.

Venous and Lymphatic Drainage of

Non Muscular Anatomy Hip.

Abdominal wall Abdominal muscles.

Dr. Fadel Naim Orthopedic Surgeon IUG

Anterior Posterior Medial Fascial Compartments of the Thigh

How to work with children who have hip problems?

Hip & Lower Limb Muscles

Ultrasound of the Hip: Sonoanatomy

Medial Patellar Tendon Transfer

Chronic Monteggia Injury

A Method for Capsular Management and Avoidance of Iatrogenic Instability: Minimally Invasive Capsulotomy in Hip Arthroscopy Csaba Forster-Horvath, M.D.,

Muscles of Thigh.

Chapter 18 Hip Hip bone – aka os coxae; ilium, ischium & pubis.

Periportal Capsulotomy: A Technique for Limited Violation of the Hip Capsule During Arthroscopy for Femoroacetabular Impingement Emily J. Monroe, M.D.,

Arthroscopic Decompression of a Type III Subspine Impingement

ARTERIES OF THE LOWER EXTREMITY

Frontal aspect of thigh

ANTERIOR & MEDIAL COMPARTMENTS OF THIGH

Arthroscopic Decompression of a Type III Subspine Impingement

Michael Albert, MD Bio: Chief of Orthopaedics, Dayton Children’s Hospital Attended Wright State University School of Medicine Expertise in spinal deformity.

Presentation transcript:

Technical Problems to Avoid in Performing Open Reduction of DDH 5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery Symposium Sao Paulo, Brazil October 11-14, 2017 Technical Problems to Avoid in Performing Open Reduction of DDH Perry L. Schoenecker, M.D. St. Louis Shriners, St. Louis Children’s & Barnes Hospitals, Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA No Conflicts, No Disclosure

Technical Problems to Avoid in Performing Open Reduction of DDH 5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery Symposium Sao Paulo, Brazil October 11-14, 2017 Technical Problems to Avoid in Performing Open Reduction of DDH Perry Schoenecker, MD No Conflicts Or Disclosures Pertinent To Presentations

Tensor sartorius interval Rectus tenotomy Anterior arthrotomy Adductor tenotomy Possible PFO

First obtain lateral exposure . . . Reflect abductors off capsule

Then expose anterior & medial capsule Tight psoas Femoral nerve Iliopsoas tendon

obtaining lateral, anterior & MEDIAL capsule is critical

Deformed head Colin Moseley, et al Arthrogram

Lateral capsulotomy Medial capsulotomy

Beware of critical arterial blood supply Capsulotomy Beware of critical arterial blood supply

Ogden JA. JBJS A 1974; 56:941. Medial circumflex artery Lateral circumflex artery Medial circumflex artery Ogden JA. JBJS A 1974; 56:941.

Ogden JA. JBJS A 1974; 56:941.

Ganz R. JBJS B 2000 Ogden JA. JBJS A 1974; 56:941.

Open capsule medially & cut transverse ligament Excise Transverse acetab. lig Open capsule medially & cut transverse ligament Excise ligamentum teres

Open capsule medially & cut transverse ligament Transverse acetab. lig Open capsule medially & cut transverse ligament

Beachey, Janelle

Capsule Labrum True acetabulum Head False acetabulum

Medial Capsule

Dislocated Reducing Reduced

Your closure stitch is very close to the terminal branch of the medical circumflex Pena, Sade

Close carefully

Most Medial capsule should open after closure Femoral nerve Iliopsoas tendon Medial capsule pre-reduction is contracted

Hip still laterally dislocated . . . Why?? Failing to Reduce Hip still laterally dislocated . . . Why??

Osteotomies are not a substitute for a poorly performed open reduction Failure occurred because medial capsule not opened Osteotomies are not a substitute for a poorly performed open reduction

Tight psoas, medial capsule contracted Must clearly expose anterior & medial capsule Femoral nerve Iliopsoas tendon Tight psoas, medial capsule contracted

obtaining lateral, anterior & MEDIAL capsule exposure prior to capsulotomy

Open capsule medially & cut transverse ligament Transverse acetab. lig Open capsule medially & cut transverse ligament

• Attempt reducing fem head medially into true acetab False acetab • Reducible (too tight?) . . . . How stable?

Post re-do R hip and now L open reduction

Obrigado -------------- Thank you