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Residual shortening after osteotomy for Perthes' disease. A comparative study
The Journal of Bone and Joint Surgery. British Volume
|March 1, 1984
Summary
Subtrochanteric varus derotation osteotomy and weight-relieving calipers resulted in identical average limb shortening. Residual shortening primarily depends on growth plate ossification, with better outcomes in younger children undergoing specific osteotomy techniques.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Limb length discrepancy
Background:
- Limb length discrepancy is a common complication in pediatric orthopedic conditions.
- Subtrochanteric varus derotation osteotomy and weight-relieving calipers are treatment options.
- Understanding factors influencing residual shortening is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare residual limb shortening between subtrochanteric varus derotation osteotomy and weight-relieving calipers.
- To identify factors influencing residual shortening after these treatments.
Main Methods:
- Retrospective comparison of 55 patients treated with osteotomy and 71 patients treated with calipers.
- Analysis of skeletal maturity, follow-up duration, and residual limb length.
- Correlation of residual shortening with age at onset, surgical technique, and anatomical results.
Main Results:
- Average residual shortening was 0.9 cm in both treatment groups.
- Initial shortening from osteotomy often corrected over time as the varus angle reduced.
- Residual shortening was influenced by the degree of proximal femoral growth plate ossification inhibition.
Conclusions:
- Both surgical and conservative treatments yielded similar average limb shortening.
- Younger children (under seven at onset, under eight at operation) with good anatomical results showed less residual shortening after open-wedge osteotomy.
- Proximal femoral growth plate ossification is a key determinant of final limb length.