A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip by Ting-Ming Wang, Kuan-Wen Wu, Shier-Chieg Huang, Wei-Cheng.

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Presentation transcript:

A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip by Ting-Ming Wang, Kuan-Wen Wu, Shier-Chieg Huang, Wei-Cheng Huang, and Ken N. Kuo JBJS Essent Surg Tech Volume 3(4):e19 October 9, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Markers for skin incisions. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Marker for iliac crest incision. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Iliac crest incision. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Straight head of rectus femoris. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Iliopsoas tendon. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Marker for capsular incision. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ligamentum teres isolated. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Ligamentum teres divided, and traced down to the joint. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The femoral head is not reducible. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Marker for vastus lateralis incision. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Parallel pins inserted for rotational orientation. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Parallel pins viewed from caudally. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

C-arm view showing two pins in parallel position. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Marking of the osteotomy site under c-arm fluoroscopy. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Additional rotation marker. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

With use of the plate as a template, two proximal predrilled holes are made. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The femur is cut with an oscillating saw at the predetermined marker. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

With use of the proximal Steinmann pin as a joystick, the femoral head is reduced. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The amount of overlapping while the femoral head is in the reduced position is the amount of femoral shortening required. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

C-arm view showed the amount of shortening required while the femoral head is in a reduced position. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The fragment is removed from the proximal end of the distal fragment. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The divergence of two Steinmann pins indicates the amount of external rotation (30° in this case) of the distal osteotomy fragment. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The fragment, of about 1.2 cm, removed for shortening. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

After the Pemberton procedure, the femoral head is in stable position. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

C-arm view demonstrating a well-reduced hip. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Figs. 26 through 29 Illustrative case (also see Video 5). Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Bilateral frog-leg lateral pelvic radiograph demonstrating the same high bilateral dislocation with acetabular dysplasia. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior pelvic radiograph made with the patient wearing a cast shows the right femoral head in good position with adequate acetabular coverage. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior pelvic radiograph made with the patient wearing a cast after the same procedure on the other side. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Figs. 30 through 34 Illustrative case with long-term follow-up. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior pelvic radiograph following the combined procedure on the right hip. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior pelvic radiograph following the combined procedure on the left hip. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior pelvic radiograph nine months following the bilateral procedure. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.

At ten years postoperatively, both hips were congruent and well located as seen on this anteroposterior pelvic radiograph. Ting-Ming Wang et al. JBJS Essent Surg Tech 2013;3:e19 ©2013 by The Journal of Bone and Joint Surgery, Inc.