Transcript عرض تقديمي من PowerPoint

DAMASCUS HOSPITAL
Dr.MHD BASHAR ALBOSHI
‫‪Open reduction with femoral shortening‬‬
‫ضغط شديد يطبق على رأس الفخذ((عادة يمكن إجراء إفتراق عدة‬
‫ملمترات بدون تشكيل قوة شد أكبر))‬
‫يجرى عند األطفال<‪2‬سنة‬
Femoral Shortening and Derotation Osteotomy combined with
Open Reduction of the Hip
•The amount of shortening: distance between the
inferior margin of the femoral head and the floor
of the acetabulum OR measure the overlap of the
osteotomized segments after reduction .
The Complications(Avascular Necrosis)
‫على‬excessive pressure ‫تحدث عند تشكيل ضغط شديد‬
.‫رأس الفخذ‬
‫)‪The Complications(Avascular Necrosis‬‬
‫التشخيص ‪: DIAGNOSIS‬‬
‫فشل التكلس أو النمو خالل سنة‪.‬‬
‫زيادة عرض عنق الفخذ‬
‫تغيرات بكثافة العظم‪.‬‬
‫تشوه( اضطرابات نمو)‬
Classif…..table15-5

Interrvention to alter the effects of AVN:
Trochanteric Epiphysiodesis.
Trochanteric Advancement.
Intertrochanteric Double Osteotomy.
Lateral Closing Wedge Valgus Osteotomy
With Trochanteric Advancement.
Interrvention to alter the effects of AVN:
Trochanteric Epiphysiodesis.
Trochanteric Advancement.
Intertrochanteric Double Osteotomy.
Lateral Closing Wedge Valgus Osteotomy
With Trochanteric Advancement.
Greater Trochanteric Epiphysiodesis
(Langenskiold)
•Be done when major AVN is recognized and the ossific nucleus of the greater
trochanteric present.
•The most effective if performed when the child is around 5 yrs old.
•Ineffective if done when the child is much more than 8 yrs old.
Distal And Lateral Transfer Of
Greater Trochanter
•Be considered :
• when an objectionable abductor limp results from trochanteric overgrowth.
• when the greater trochanter reached the level of the top of the femoral head.
•Concentric reduction of the hip.
•Trendelenburge’s sign (+).
•Child > 8 yrs
Latersl Advacement Of The
Greater Trochanter
Wagner’s Intertrochanteric
Double Osteotomy
.
Teratological Dislocations
A teratological dislocation of the hip is one that occurs sometime
before birth, resulting in significant anatomical distortion and
resistance to treatment.
It often occurs with other conditions such as arthrogryposis,
Larsen syndrome, myelomeningocele, and diastrophic dwarfism .
The anatomical changes in teratological dislocations are much more
advanced. The acetabulum is small, with an oblique or flattened
roof, the ligamentum teres is thickened, and the femoral head is of
variable size and may be flattened on the medial side ,The hip joint
is stiff and irreducible, and roentgenograms show superolateral
displacement .
Most authors agree that closed reduction is not effective and that
open reduction is necessary.
Teratological Dislocations
A teratological dislocation of the hip is one that occurs sometime
before birth, resulting in significant anatomical distortion and
resistance to treatment.
It often occurs with other conditions such as arthrogryposis,
Larsen syndrome, myelomeningocele, and diastrophic dwarfism .
The anatomical changes in teratological dislocations are much more
advanced. The acetabulum is small, with an oblique or flattened
roof, the ligamentum teres is thickened, and the femoral head is of
variable size and may be flattened on the medial side ,The hip joint
is stiff and irreducible, and roentgenograms show superolateral
displacement .
Most authors agree that closed reduction is not effective and that
open reduction is necessary.
Teratological dislocation of left hip in
18-month-old girl. B, Appearance at
3 years of age after primary femoral
shortening, anterior open reduction,
and innominate osteotomy.
MoKazem.com
‫• هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل األطباء المقيمين‬
.‫ بشار ميرعلي‬.‫ تحت إشراف د‬,‫في شعبة الجراحة العظمية في مشفى دمشق‬
.‫• الموقع غير مسؤول عن األخطاء الواردة في هذه المحاضرة‬
• This lecture is one of a series of lectures were prepared and
presented by residents in the department of orthopedics in
Damascus hospital, under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may exist in this
lecture.
Dr. Muayad Kadhim
‫ مؤيد كاظم‬.‫د‬