SCHANZ OSTEOTOMY A FADING ART

The pelvic support osteotomy is a useful surgical procedure for the salvage of damaged hips of patients in whom arthrodesis or hip arthroplasty are not appropriate either surgically or nancially. It is a procedure that has much to offer the adolescent or young adult who has painful limping, restriction of hip motion and early onset fatigue to walking as a consequence of hip destruction from AVN, TB hip, old neglected dislocation of hip, neglected acetabulum fracture or persistent severe hip dysplasia. A successful pelvic support osteotomy reduces limp by reducing the Trendelenburg lurch and compensating the limb length inequality. It provides stability by taking support on the hemipelvis and facilitates a more energy-efcient gait. In this article, the authors present their own experience with palliative Schanz osteotomy.

PELVIC SUPPORT OSTEOTOMY WITH ILIZAROV METHOD;

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarovmethod in patients undergoing Girdle stone procedure in terms of pain relief and limb lengthdiscrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedicand Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore.Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow upfor next one year after the procedure. Materials and Methods: Forty five patients having hipjoint problems were included. The radiographs would include plain radiographs of the pelvisin neutral and single limb standing position and the femur of involved side to assess the pelvicobliquity. Surgery was performed in the supine position under spinal anesthesia. A proximalfemoral osteotomy was performed at the level of ischial tuberosity. The other distal femoralosteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomieswere then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/dayfor lengthening. Results: There were 30 male patients and 15 were female patients with maleto female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among allpatients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion:By using the Ilizarov technique, we could prevent the valgus effects created by the valgusextension osteotomy while achieving lengthening of the femur through the distal osteotomy inthe femur. It is an excellent technique for those patients who are not fit for total hip replacement.

Pelvic Support Osteotomy; Salvage Procedure in Chronically Dislocated Hips Case Report: Technical Note on the On-lay Bone Positioning of a Lengthening Nail and Review of the Literature

Background:Young patients with a acquired dislocation of the hip with concomitant shortening of the lower limb is a difficult diagnostic problem with few definite treatment options.Methods:We used the technique, originally described by Ilizarov, with a double femur osteotomy and lengthening the femur. Lengthening was done with a sub muscular placed on-lay femur distraction rod. Distraction of the rod was done by fluid mechanics. After lengthening, the distraction was secured by a parked plate by locking the distal part of the plate.Results:This patient needed a lengthening of 60 mm, distraction time was 36 days with a distraction index of 1.61 mm per day and a healing index of 31.4 days per cm lengthening.We encountered one complication in which an exchange of the plastic feeding tube was needed at 20 days post-surgery.Conclusions:In the reported case we could improve gait with reduced limping and equalizing her leg length discrepancy.