An improved method for cable grip fixation of the greater trochanter after trochanteric slide osteotomy.
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ABSTRACT:
SUBMITTER: Thakur NA
PROVIDER: S-EPMC5555050 | biostudies-other | 2010 Feb
REPOSITORIES: biostudies-other
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Project description:In this paper, we wished to determine: (1) if a greater trochanteric epiphysiodesis (GTE) slows the growth of the greater trochanter; (2) if bone peg epiphysiodesis or screw epiphysiodesis is more effective at slowing greater trochanteric growth; and (3) if a GTE is most effective in young (<8 years) or older (>8) age. In this retrospective study, 35 children with unilateral Perthes disease underwent GTE. The height of the greater trochanter was measured radiographically at the time of surgery and at least two years after surgery. The untreated opposite side, which showed no radiographic evidence of Perthes disease, was used as a control. Epiphysiodesis was performed by using multiple drill holes and either a screw or a bone peg. Mean age at the time of surgery was 7 years (range, 3.2 to 12.2 years) and mean follow-up was 58 months (range, 24 to 104 months). We found that the growth of the greater trochanter that underwent epiphysiodesis was inhibited by 0.9 mm/year, as compared to the unaffected side (p=0.007). Greater inhibition (1.8 mm/year) was noted in children who underwent a bone peg epiphysiodesis and also, surprisingly, in those over 8 years of age.
| S-EPMC2532264 | biostudies-other
Project description:Therapeutic extra-articular hip endoscopy is an effective treatment of greater trochanteric sciatic nerve impingement. We describe in detail technical pearls of the procedure including positioning, portal placement, and steps to obtaining adequate decompression while avoiding iatrogenic nerve injury.
| S-EPMC5766443 | biostudies-literature
Project description:Greater trochanteric pain syndrome (GTPS) is a pathology that can involve the trochanteric bursa or the tendons which attach to the greater trochanter. To clarify the potential importance of bursa versus tendon pathology and of substance P (SP) in contributing to pain in this condition tendon and bursa tissue biopsies were obtained from 34 patients with GTPS and 29 control subjects. Specimens were evaluated via light microscopy for histopathological and morphological differences, as well as using immunohistochemistry for macrophages (CD68), inflammatory cells (CD45) and SP. Bursa [stroma score, mean (SD): 4.18 (1.65) vs. 2.53 (1.61), p = 0.051] and tendon [Bonar score, mean (SD): GTPS mean (SD) 12.65 (2.0), control (10.43 (4.84), p = 0.04] from subjects with GTPS demonstrated more extensive signs of pathology than specimens from control subjects. There was a significantly greater presence of SP in the bursa (frequency: 9/12 vs. 6/16, p = 0.047), but not in the tendon (8/12 vs. 8/15, p = 0.484) of subjects with GTPS compared to controls. An increased presence of SP in the trochanteric bursa may be related to the pain associated with GTPS.
| S-EPMC4856521 | biostudies-literature
Project description:PurposeLegg-Calvé-Perthes disease often leads to greater trochanteric overgrowth, which negatively affects the biomechanics of the hip joint. This study aimed to evaluate the physiologic growth of the greater trochanter and the effectiveness of greater trochanteric epiphysiodesis radiographically.MethodsRetrospectively, 46 children (33 male, average age at greater trochanteric epiphysiodesis 8 ± 1.3 years) with unilateral Legg-Calvé-Perthes disease undergoing greater trochanteric epiphysiodesis with screws and curettage of the epiphysis were included. On radiographs of the pelvis pre- and postoperatively (mean follow-up 3.5 years), trochanteric height, articulotrochanteric distance, and center-trochanter distance were determined and compared to the unaffected side. Reference values for the physiological development of trochanteric height, articulotrochanteric distance, and center-trochanter distance over time were established.ResultsGreater trochanteric epiphysiodesis reduced trochanteric growth by 29% measured by trochanteric height, but only statistically significant in the group "<8 years" (p = 0.02). Regression analysis revealed inhibition of trochanteric growth of 0.92 mm/year. Both articulotrochanteric distance and center-trochanter distance of the affected and unaffected side converged during the follow-up period: articulotrochanteric distance of the affected hip increased (preop: 11.2 ± 7 mm, maturity: 18.5 ± 10 mm; p < 0.01) compared to no change on the unaffected side (preop: 19.3 ± 5 mm, maturity: 18 ± 6 mm; p = 0.69). Center-trochanter distance of the affected hip stayed unchanged (preop: (-7.9) ± 7 mm, maturity: (-7.8) ± 9 mm; p = 0.13). On the unaffected side, center-trochanter distance became negative (preop: 0.9 ± 6 mm, maturity: (-6.5) ± 5 mm; p < 0.001). Measured by articulotrochanteric distance and center-trochanter distance, 31.8% achieved an optimal result.ConclusionGreater trochanteric epiphysiodesis has a positive effect on greater trochanter growth and therefore on hip anatomy. Further studies must show whether these positive effects also result in biomechanical and functional benefits.Level of evidencelevel III.
| S-EPMC10984151 | biostudies-literature
Project description:Closed-wedge high tibial osteotomy (CWHTO) is more advantageous over open-wedge high tibial osteotomy in the following viewpoints: (1) compression force from the patellar tendon to the osteotomy site contribute to its stability, (2) patellar baja less likely occurs, and (3) hardware implant is placed under the thick muscle, which could prevent risk of irritation and infection. Although conventional CWHTO resects the wedge bone, including the anterior and posterior cortices, interlocking CWHTO preserves them while performing osteotomy for the anterior or posterior cortex with only the proximal or distal osteotomy line, respectively. When the wedge is being closed, the distal fragment is internally rotated overlying the anterior and posterior cortices on the proximal and distal cortices, respectively. As a result, good rotational stability and anterior advancement of the tibial tubercle are obtained. Interlocking CWHTO can be applied for patients with moderate patellofemoral osteoarthritis. Adopting an oblique osteotomy line enables secure multiple screw fixations for a long locking plate with a good fitting, allowing early postoperative weightbearing.
| S-EPMC8085353 | biostudies-literature
Project description:PurposeTo report a new flanged intrascleral fixation technique for subluxated or dislocated intraocular lens (IOL) with c-loop or double c-loop haptics (cable tie fixation method).ObservationsWe introduced a cable tie fixation method using 6-0 polypropylene for subluxated multifocal IOL with C-loop or double C-loop haptics. After passing the 6-0 polypropylene monofilament under the optic-haptic junction, the other end of the strand was taken out of the eye after passing it above the optic-haptic junction. A knot was made at one end, and the opposite strand was passed through the knot to form a loop. Both ends of the monofilament were tugged to make the loop fixed to the optic-haptic junction smaller. Both ends of the monofilament were externalized 2.5 mm posterior to the limbus using a 30 G needle. Another 6-0 polypropylene monofilament was tied to the opposite optic-haptic junction and scleral fixation was performed. While checking the IOL centration, the four ends of the 6-0 polypropylene monofilaments were heated with a cautery to form flanges.Conclusions and importanceA four-flanged intrascleral fixation technique involving a cable tie-shaped loop using 6-0 polypropylene could provide stable IOL fixation without damage for subluxated or dislocated IOLs with C-loop or double C-loop haptics.
| S-EPMC9263869 | biostudies-literature
Project description:BackgroundGreater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis.MethodsA prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing.ResultsAt 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function.ConclusionsGTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution.Level of evidenceLevel II Natural history Study.
| S-EPMC8691027 | biostudies-literature
Project description:ObjectivesGreater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness of isometric and isotonic exercise for individuals with GTPS.MethodsThis randomised controlled pilot trial recruited 30 participants with GTPS. Both programmes consisted of daily, progressive home exercise for 12 weeks with 8 individual physiotherapy sessions over the trial period. The primary outcome measure was the Victorian Institute of Sport Assessment-Gluteal (VISA-G) and secondary outcome measures included the Numeric Pain Rating Scale (0-10) and an 11-point Global Rating of Change Scale. Outcome measures were assessed at baseline, 4 and 12 weeks.ResultsTwenty-three participants completed the trial. After 12 weeks, mean VISA-G scores improved in both groups; 55-65 in the isometric group and 62-72 in the isotonic group. 55% of the isometric group and 58% of the isotonic group achieved a reduction in pain of at least 2 points (minimally clinically important difference (MCID)) on the Numeric Pain Rating Scale. 64% of the isometric group and 75% of the isotonic group had improved by at least 2 points (MCID) on the Global Rating of Change Scale.ConclusionIsometric and isotonic exercise programmes appear to be effective for individuals with GTPS and should be considered in the loading management of patients with this condition.
| S-EPMC6797310 | biostudies-literature
Project description:Background:Perthes disease is a condition in which a self-limiting avascular event affects the capital epiphysis of the femur with a very variable course. It has been shown frequently, however, that there is a group of patients who definitely benefit from containment, either surgical or nonsurgical, better with surgical. We studied midterm to long term outcome of closed wedge varus derotation osteotomy (VDRO) with trochanteric apophysiodesis in Perthes disease. Materials and Methods:88 children with mean age of 7.9 ± 2 years, belonging to Herring's lateral pillar Groups B and C treated with VDRO with trochanteric apophysiodesis were included in this study. Radiological evaluation was done using Mose's index, the epiphyseal quotient, the articulotrochanteric distance and center edge angle of Wiberg. Results:Containment was achieved in all patients on postoperative radiographs. At a mean followup of 12 years, good results were obtained in 66, fair in 19, and poor in 3 patients using Catterall's postoperative classification. Conclusions:VDRO is an effective containment method of femoral head for patients belonging to the Herring's Group B and also effective in many patients belonging to Herring's Group C. It is a good procedure to attain containment in children <9 years of age. Trochanteric apophysiodesis reduces risk of limping.
| S-EPMC6241054 | biostudies-other
Project description:Improvements in materials, components, and surgical techniques in cementless total hip arthroplasty are resulting in improved femoral stem fixation through bony ongrowth or ingrowth. While improved femoral stem fixation is one reason for the current excellent total hip survivorship, indications for stem removal such as infection, implant fracture, or osteolysis remain. A commonly used technique for fully ingrown femoral stems is an extended trochanteric osteotomy which can result in comminuted fractures of the proximal femur during stem removal requiring additional fixation. Therefore, a novel hip stem removal was developed to facilitate removal of these well-ingrown stems without the need for an extended trochanteric osteotomy. This study describes the removal system and surgical technique and presents a case series of successfully removed ingrown stems.
| S-EPMC8435937 | biostudies-literature