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Innominate osteotomy for Perthes' disease
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Innominate osteotomy shows satisfactory clinical outcomes for Perthes
Area of Science:
- Pediatric Orthopedics
- Pediatric Orthopedic Surgery
Background:
- Perthes' disease affects children, potentially leading to poor prognosis.
- Innominate osteotomy is a surgical intervention for severe cases.
- Patient selection criteria include age, Catterall grading, and femoral head uncovering.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of innominate osteotomy in children with Perthes' disease.
- To define optimal indications and timing for innominate osteotomy.
Main Methods:
- Retrospective review of 70 children undergoing innominate osteotomy for Perthes' disease.
- Follow-up period ranged from 2 to 11 years (average 4.3 years).
- Radiological outcomes assessed using Sundt criteria.
Main Results:
- Satisfactory clinical results were observed in the majority of patients.
- Radiological outcomes: 54% good, 19% fair, 27% poor.
- Postoperative stiffness occurred in 7 children, often associated with late surgery or preoperative hip issues.
Conclusions:
- Innominate osteotomy is indicated for children over 6 with significant femoral head involvement and uncovering.
- Optimal surgical timing is within 8 months of presentation.
- Careful patient selection is crucial to maximize positive outcomes and minimize complications.
Abstract:
Seventy children who underwent innominate osteotomy for Perthes' disease were reviewed. They had been subjected to this surgery because they were considered to have a poor prognosis as indicated by age, Catterall grading, and by the presence of uncovering of the femoral head. The period of follow-up ranged from 2 to 11 years and averaged 4.3 years. The clinical results were satisfactory. The radiological results were graded (using the Sundt criteria) as good in 54%, fair in 19%, and poor in 27%. Seven children developed postoperative stiffness sufficient to require hospitalization; usually these and the children with a poor result had been subjected to late surgery and had significant hip irritability or femoral head deformity preoperatively. Based on this analysis, our indication for innominate osteotomy is for a child, over the age of 6 years, with the greater part of the femoral head affected by the disease and uncovering of the femoral head. The surgery should be performed within 8 months of presentation.